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� cRMIT APPLICATIvN <br /> CITY OF EVERETT ?ERMIT 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 � — I C' —D�J <br /> SITE ADDRESS PARCEI TAX I.D.tl PERMIT i <br /> - L � � � S�' �Mf73 - b2a <br /> LEGA LOT NO. BLOCK TRACT OR 8UBDMSION K <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE <br /> 1ENANT NAME I CONTACT FOR PERMIT PHONE <br /> E�MIAIL <br /> n,i . �,� Ar•-�,� �Sv�>1'1'3�e k,., 20 2�4 ZY <br /> ��y,�, <br /> CON1R.LICENSE K r�`1 � � v p7��D ��"��— <br /> Y / <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ,, v <br /> Electric Gas Other /lJqy' <br /> WORK DESCRIPTION <br /> C �''� 1'�1����/ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FOCTURE OR ITEM <br /> Toiiel AIC—air handling units <br /> Bathtub Forced air systems <br /> _ Lavatory(wash basin) � Gas pip(ng <br /> Shower Waler heaier <br /> Kitchen sink&disposal Gas flreplace <br /> Dishwasher J= Gasrange <br /> Clothes washer Cbthes dryar <br /> Waler heater Range hood <br /> Sink(service/bar/mupletc.) Exhaust fan <br /> Backflow preventer Healpump <br /> Urinal Unit healer <br /> Drinking Founlain Boiler <br /> Floor drain Refigeralion <br /> Grease trap Woodslove <br /> Roof drains _, O[her��✓.r� /.'_�,LI..L <br /> Other <br /> CITY OF EVERETT LOCILL SALES TIU(CODE IS 3105 <br /> I hereby ceritity that I have read and examineA lhis application and know ihe same to be true and correcl. All provisions of laws 2nd <br /> ordinaces governing this type of work will be complied with whelher specified herein or not.The granting of a permit does not presume <br /> lo give authority to violate or cancel the provision of any other state or local law regulating conshuction or the pertortnance of <br /> constructiun.That I am authorized by the owner of this property to perform the work for which application is made and I comply wilh lhe <br /> Slate Contracbrs Law 18.27 RCW and 296200 WAC. <br /> �!�-�/ � '�y'CJ <br /> Signature of OwnedContractorlAuthorized Agent Date <br />