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ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERWICES <br /> 3200 CEDAR S7REET, EVERETT, WA 982�1 <br /> 425-257-8810— FAX 425�57-6857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N RMIT x <br /> 9 �- 011f1'�F� Q�� � O000 $ d 'l�t/'� <br /> LEGA LOT NO. BLOCK TRACT OR SUODMSIOH/ <br /> oesc. 1 ao a, - �36 -a'I <br /> OWNER DD � 1 P PHONE <br /> .� 47�5-'1�13 <br /> A �e,.o F_,..�a�a�s� � Lt-c l� b a �� A�e E P�a�lis.�l.� t,� 9So1�. i�i8 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> 4'�S'"1V3- 111& <br /> (,.. .�1 �e.SS��1 <br /> N7RA �y� EaMAIL � <br /> � ��1 <br /> Ad2w�rt. Fn�pn,sesLl-t »o3a•3S quesE F�e�-LL�bo��. 4as-`1�13 -t^lt <br /> CONTR.UCENSE R <br /> AbAiar-1.d3at�1 . <br /> USE OF BUILDING HEAT 30URCE CONTRACT PRICE OF WORK <br /> s�Y� �t ��,n„� l ' _,Electric _Gas ✓Other � �O o vo <br /> WORK ESCRIPTION <br /> C"uM,p�iu�,t,4�..`_.°�a` 'i.l�rv.� �'e►n�.�--�. \ �.3J 4$.�-"t". <br /> PLUMBING MECHANICAI <br /> �• TYPE OF FU(TURE OR ITEM NO. TYPE OF FIXTUqE OR ItEM <br /> � Talel � A/C-air handiing units <br /> � Bethtub I Forced air systems <br /> �,,,_ LavaMry(wesh basin)(�� 3 Gas piping � ( <br /> J Shower j � Water heater J <br /> ___j_ Kitchen sink 8 disposal � � Gas fireplece� <br /> � Dishwasher � <br /> � Clothes washer � —L Gas range( - <br /> ��_ .� Clothes dryer � <br /> , Sink(servlce/baNmey/etc.) � Range hood / <br /> Backflrnv preventer � Exhaust fan �� �� <br /> — Heatpump <br /> _ Urinal Unit heater <br /> _ Drinking�=ountain Boiler <br /> _ Floor drain Refigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> _ Other — <br /> CITY OP EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby certify Ihet I have read and exemined this epplication and know the same to be Irue and corred. All provisions of laws and <br /> ordinances govening this type of work will be complied with whether specified�erein or not.The granting of a pertnit does not presume <br /> to give authority f�videte or cancel the provision of any other state or local law regulating construction or the perfortnance of <br /> construction.Thet I am authorized by the owriei of this property to perfertn the work for which application is made artd I comply with the <br /> State Cordraciors Law 18.27 RCW and 296:200 WqC. � <br /> �,�_ � � � � , ai ��. � <br /> aigneturc r vwneric,ontractor/A6thonzed Agent Dete I <br /> � <br />