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PEt2MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> �( /,, i T L-- APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITc ADnRESS PARCEL TAX I.D.# PERMIT# <br /> ;� � zb n��N � r-�� �� wa�r �vs,�g000�iav co���-o�� <br /> LEGAL LOT NO. BLOCK TR �R�BDIV �N N� �� <br /> OESC. � Yit� <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��e KoTo�� `fsolc ( SIo ) � 2�H bJ� �,t� L`{✓� (�K1ou� W/k Q$o37 <br /> TENANT NAME I �ONTACT FOR PERMIT PIiONE <br /> W�" L c E-MAIL <br /> TR OR A RESS � � <br /> C:ob�lesTo�� coT,�Cr i/v�,/�Z.S l(� �,�wr � ,�s kDd�,� ?-E' 6�'�26"�%�� <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORI: <br /> SG� _Eleclric _Gas� Other <br /> � <br /> WORK DESCRIPTION <br /> � �rb�y 1�� , c �y� <br /> S r P�- (�S� —U )`6 �� X L� ZME�HANICAL <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM NO. !Y'PE OF FIXTURE OR ITEM <br /> '{ Toilel _ NC—air handling units <br /> �� BaQitub Forced air syslems <br /> Lavalory(wash basin) I Gas piping <br /> � Shov+er Waler healer <br /> �_ Kilchen sink&disposal � Gas tireplace <br /> J_ Dishwasher Z Gasrange <br /> � Clothes washer � Cloihes dryer <br /> � Waler healer Range hood <br /> Sink(serviceNarimop/elc.) � Exhaust fan <br /> � BackOow preventer _ Heatpump <br /> Urinal _� Unit healer <br /> Drinking Fourtain Boiler <br /> rt— Fioordrain _ Refrigeralion <br /> Grease trap _ Woodslove <br /> � Roof drains _ Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify thal I have read and er.amined this applicalion and know lhe same lo be Irue and correcL All provisions o(laws and <br /> ordinaces goveming lhis type of work will be complied with whether s,eci(ied herein or noL The granting of a permit does not presume <br /> lo give aulhority lo violate or cancel lhe provision nf any olher slate or local law regulating construction or fhe peAormance of <br /> construclion.Thal I am aulhorited by lhe owner of this property lo perform lhe work for which applicalion is made and I comply wilh the <br /> Stale Conlractors Law 18.27 RCW and 296.200 WAC. <br /> i��� i1�-= - 61�l o� <br /> Signature o(OwnedCo tra todAuthonzrd Agent Date �IL <br />