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� r }� <br /> t � <br /> P'ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE7T, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM 70 4 PM �� ,/3 '/U <br /> SITE ADDRESS PARCEL TAX I.D.k /g�� RMIT k <br /> " '' : �' - wlni �. I �..�a. P�' Ocfi3���o00o ISvo l� ,1,, 'J� <br /> LEGA lOT N0. BLOCK TRACT OR SUBDIVISION 1i <br /> DESC. � Shor�� S�hd�,vS,u„ 31 p�- 03 ff <br /> ONMER ADDRESS CITY2IP PHONE <br /> wr�u;� En+ ���3Z 3S�' 14�t Se aa�< <� �,,�. �txo�Z tizs-,H3.,,i� <br /> TENANTNAME I CONTACTFORPERMIT PHONE �}'�S' '�13 ' l'llf( <br /> L-��I_�ss( � <br /> E-MAIL <br /> PdH�( Evt�•L�-L <br /> CONTR.LICENSEN 1-1 (�3-L 3S}�y� ryU( � � 1„ `I WH I���Z �125- �ti3- ���Y <br /> 19�KuRti�o�2c,l ��"� <br /> USE OF BUILDING y HEAT SOURCE CONTRACT PRICE OF WORK <br /> S..i,... . r' �.<4.s.1_l v � <br /> � � _Electric l�Gas__Other I `I � ��'u" <br /> WORK DESCRIPTION 2�� <br /> ��t;�� � <br /> ��R ,�1�( ��tYY���`ilC .������� , � <br /> � ��;,r,�l' 1 <br /> PLUMBING � MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Batlhtub � Fo ced aihsyst ms nits <br /> �-1 Lavatory(wash basin) �) Gas piping <br /> `' -Z Shower � Waler heater <br /> I Kitchen sink 8 disposal f Gas fireplace <br /> I Dishwasher � Gas range <br /> 1 Clothes washer � Clothes dryer <br /> ,y� Water healer Range hood <br /> O� Sink (service/bar/mop/elc.) �{� Exhaust fan <br /> Q Backflow preverler O Heat pump <br /> � �rinal _� Unit heater <br /> Q Drinking Fountain Boiler <br /> 0 Floordrain Refrigeration <br /> O Grease trap Q Woodstove <br /> D Roof drains 0 Other <br /> Other_ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify lhat I have read and examined this appiication and know the same to be true and corred. All provisions of laws and <br /> ordinances goveming this type of work will be wmplied with whether specified herein or not.The granting of a pertnit dces not presume <br /> to give authority to vidate or cancel the provision of any other state or local law regulating construdion or the perfortnance of <br /> conslruction.That I am authorized by the owner of this property to perform the work for which applicalion is made and I comply with the <br /> State Contradors Law 18.27 RCW and 296200 WAC. <br /> � <br /> � �'•,,.. ' �,� (e � l l o / <br /> Signature f OwnedCoMracbr/ thorized Agent Date ' 2 <br />