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F :RMIT APPLICATI�N <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 <br /> SITE ADDRESS , ; � PARCEL TAX LD.# PERMIT# <br /> � ;�; Z Z � �r��,��1 ►71(.b4�-Cb2 <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION k <br /> DESC. <br /> OWNER ADDRESS CITY2IP PNONE <br /> �� �� � � �� o ����. �-w� u5�.. � � a � �t� -� r /��. �,z � 3 � 8 �775 <br /> TENANTNAME I CONTACTFORPERMIT l PHONE <br /> �,J 1 1 � l 3c � 577 � <br /> —'\��t C �+i/f � � cY\�— �-�„� i'JSu,^ E-MAIL _ <br /> Z`bNYfxA�'rGft-' `TI I <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE,OF WORK <br /> JJ <br /> C� L� �_� _Eledric _Gas�C Other N"`�� � l� � �� , <br /> L i <br /> WORK DESCRIPTION <br /> Y � . 1, �� �. �7=� s� � �5 G�-��S� <br /> �C. �f.� ,) � ', <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> E3athtub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal _ Gas freplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/badmop/etc.) Exhaust(an <br /> �ackflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerlify Ihat I have read and examined ihis application and know Ihe same to be true and correcL All provisions of laws and <br /> ordinances goveming this type of work will be complied with whether specified herein or not. The granting oi a permit does nol presume <br /> to give authority to violate or cancel ihe provision of any other state or local law regulaling construclion or the performance of <br /> construclion. That 1 am authorized by lhe owner of Ihis property lo perform ihe work forwhich appiicalion is made and I comply wilh the <br /> Stale Coniractors Law,1&27 RCW and 296.200 WAC. <br /> �i �-% �--� `l�� �i o <br /> Signature of Owner/ onlraclodAulhonzea"Agent Dale <br />