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P�RMIT APPLICATIGN <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 i_ a 4- �6 <br /> SITE ADDRESS PARCEL TAX I.D.# RMIT N <br /> I1I;! f,�'t��L (I1'1 , f-.Ul kl1', 9B�al octi.Fg6`ZZ3-GY'iZ-o0 � �1 <br /> LEGA LOTNO. BLOCK TRACT <br /> oEso. Y��,r, ,�,,; %�3 J^i3 Tti� �i�NTs RDD. �fOL . 3 P. 40 <br /> OWNER ADDRESS CITY2IP PFiONE��G G 6 3� <br /> J p�n UI ncen� �e �Ee� � "7 I 3 �'o c��" �,.e �o �18 �o I `f,-S- � <br /> TENANT NAME I CONTACT FOR PERMIT �� PHONE <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> CONTR.UCENSE# �� �� <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ����(�IJII _E�ectric �Gas_Other <br /> � <br /> WORK DESCRIPTION <br /> Y! I�'�X i /A�,!�� � ,,� ' � UVf�'Y. �-l.,�'{'_ � �Rd�JT pl.',�r1 S.F P. <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �_ Toilet A/C—air handling units <br /> I Bathlub Forced air sysloms <br /> �_ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink& disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/barlmop/elc.) = Exhaust tan <br /> Backflow preventer Healpump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeralion <br /> Grease crap Woodslove <br /> RooF drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby cerili(y that I have read and examined lhis applicalion and know the same to be true and cortect. All provisions of laws and <br /> ordinaces c�overning this lype of work will be complied with whether specified herein or not.The granling of a permit does not presume <br /> to give authority to violale or cancei lhe provision o(any other stale or local law regulaling construcUon or lh�pedormance o( <br /> wnslruclio t am authgii�ed by the owner ot lhis property lo perform the work for which application is made and I comply with the <br /> Stale nlracl s aw 1B�R�W and 296.200 WAC. <br /> .- <br /> .1_ �� G� 0 � <br /> Sic�naWr wnedContractor/Authorized A9ent Date � <br /> Z <br />