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��RMIT APPLICATI`vN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 3 CREDR CARDS ARE NOT ACCEPTED <br /> SITE ADD/RESS PARCEL TAX I.D./ PERMIT/ �/ <br /> � CO Ct.v�'� —`7 <br /> LEGA LOTNO. BLOCK 7RACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PM E �30' 777 <br /> /�'�k ��,�,.�s,�,� �o ,r�ex /9�8 L���,-�fi` �,� ��,�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> G�n X S��HS /`/ck L���r�s/c. ' Y�?S-3?o -J7�� <br /> CON7RACTOR � D1 ADDRESS C: 1'21P PHONE <br /> P/(�� <br /> CONTR.LICENSE N <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �/��,���y� � liElectric Gas Olher /�d � <br /> � <br /> WCRK DESCRIPTION <br /> �tiw� �,r,r�,.,� l,JallS <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FD(TURE OR ITEM <br /> Toilet AIC—air handling uNts <br /> Bathtub Farced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Laundry tray Range hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigerdtlon <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS�105 <br /> I hereby ceritlfy that I have read and examined this applicaUon and know the same to be We and correct. All proviafons oi laws and <br /> ordinaces goveminc�lhis type of work will be complied with whether specifled hereln or not.The granting of a permit does not presume <br /> to give authority to violate or cancet the provision of any other state or local law regulating construcdon or the perfortnance of <br /> construction.That I am authorized by the owner of this property to perfortn the work for which applicatlon is made and I comply with the <br /> State Conlractors L 1 .27 RCW and 296.200 WAC. <br /> �� G •->y�� S <br /> Signatu e of Owner/ nlracto uthorized Agenl Date I/ <br /> Z <br />