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- � � =RMIT APPLICATI( V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8957—www.everetlwa.org � �3-33 <br /> `� j / APPUCATIONS ARE ACCEPTED FROM e AM TO 4 PM � <br /> SITE ADDRE�_��. , ,.�/ PARCEL TAX I.D.R PERMIT A � _ <br /> ��s�- � <br /> LE LOTNO. �/� BLOCN TRACT <br /> DESC. ��I <br /> OYVNER ...,�,.�/-„ //�1DDRES$ � �E �P PHONE � ,�yl� <br /> //rrJ/�� �� y� �i IQ:F��'u�icr 9��' <br /> TENANT NAME CONTACT FOR PERM�T PHONE <br /> �1�.�'�la.� heJ �1S-?5�1 - P` <br /> CON7RACTOR DDRE8S CITYIi1P PHON <br /> mo'� y2a=�� •��70 <br /> ��,�.��E��maH�-,u� 9si5� 5�-��t/�/az, �G�'o�iu��� l�i� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eledric ✓Ges Other <br /> WORK D SC� � <br /> ' �O� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> � Toilet AIC—air handling units <br /> � Bathtub Forced afr systems <br /> � Levetory(wash basin) � Ges pping <br /> !• Shower L, WaterheWer <br /> __(__ Kitchen sink 8 disposel 1. Gea fireplece <br /> � Dishwesher � Gasranpe <br /> .,L ClotMsweafier 1 ClMhesdryer <br /> _ Leundry tray _t- Renge hood <br /> � Sink(service/ber/mop/etcJ Fxheustlan <br /> Beckflow preventer Fleet pump <br /> ~ Urinel UNlhedar <br /> Drinking Founteln '� Bdkr <br /> Floor dreln � Refriperetion <br /> Grease trep WoalMcve <br /> Roof dreins �1Mr <br /> Other <br /> CITY OF EVERETT LOCAL SALEB TAX CODE 19 J106 <br /> I hereby cerilify lhat I have reed and exemined this applicedon end knaw the same to be We and cortect. All provhiam ol lews�nd <br /> ordineces goveming th(s type of work wfll be complied with whelher spedfied hereln or not.The prentlng of e permH doea not Prs+�me <br /> to give euthority to violate or cancel the proviafon of eny other stete o�local law regulaHng eonatrudion or fhe psrform�noe o� <br /> construction.Thel i em euthorized by the ovmer of this property to perform the work tor which application fe made and I comp�y wlth 1he <br /> Stete ConUectors Lew 18.27 RCW and 286.200 WAC. <br /> j �/ (' i <br /> Signaturo o er/ ontradoNA nl ate �/; <br />