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FC :RMIT APPLICATI� ,� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 'i �a3�•�� <br /> SITE ADDRESS PARCEL TAX I.D.iC PERMIT N <br /> �Ne �'�f mi c�o+-F ' 031 <br /> LEGA LOT NO. BLOCK TRACT OR SUBDNISION k <br /> DESC. <br /> OWNER ADDRE33 CITY2IP PHONE <br /> %� yl/���1� Z3/`� �,�� �—��ie.re�" 9�,Z,�1 �-ZC��7�� I <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> CONTR.LICENSE N �w,��2 <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> S��L _Electric _Gas_Other <br /> WORK DESCRIPTION <br /> �� ,,,���� �'� -�,,,.��.� � ��s �% <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air hanCiing units <br /> Bathtub Z Forced air systems <br /> Lavatory(wash basin) �� Gas piping <br /> Shower _L Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink (service/bar/mop/etc.) _ Exhaust fan <br /> BackOow preventer _ Healpump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Reirigeration <br /> Grease irap 1Noodstove <br /> Roof drains Other <br /> Other _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE 13 3105 <br /> 1 hereby certify that I have read and examined this applicalion and know ihe same to be true and corted. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authorily to vidate or cancel ihe provision o(any other state or local law regulating consirudion or lhe performance of <br /> construction.Thal I am authorized by the owner ot this property to perform the work for which application is made and I comply wilh the <br /> State C rl¢actors La �8.27 RCW and 296.200 WAC. <br /> .�, .�;�,•� � ��-�� �0 <br /> r4'ignature o Own /Oo Mat uthonzed Agent Date <br />