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� �RMIT APPLICATIuN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SI7E DRESS F6/'• �` ������ PARCEL TAX�.D.N PERM17�Y <br /> .� G I � �c v-�- <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> ONRIER ADDRESS CITY/ZIP PHONE � Z J- ?s-7 <br /> �f�,, � 1' ,������r z��� G9/�� �� r���y��� w� ;d�<�� �ss� <br /> TENANT AME I CONTACTFORPERMIT PHONE 4Lr',ZS7 '71� <br /> /j/J%�/��i� �D�1' /1"/G� /��/�I✓`�1 e��a/"t'�d/✓1✓o� D C�. <br /> /=/J /�/JG l�'/I),�� C Ir <br /> CONTR.LICENSE 1 - <br /> USE OF BUILDING i +�•c I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> O/�r/l/r �j���(/��'� Eleciric �Gas Other � <br /> WORK DESCRIPTION .G�1���� Z �//��- �Q�f/-�1�1✓/; .(�aon ,�J./I�/l���/.(rf iz J�/�jP�1� <br /> ��r-����•-�� �,���.�. �-�, <.��z� rr�/�iJCr <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FI%TURE OR ITEM <br /> Todet A/C-a�r handlmg unds <br /> BatMub Foreed air systems <br /> Lavatory(wash basin) Gas pipmg <br /> Shower Water heater <br /> Kdchen smk 8 disposal Gas fneplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/bidmop/cic ) Er,hausl tan <br /> BackOow preventcr Heal pump <br /> Unnal Unit heater <br /> Dnnking Fountain Boiler <br /> Floor dram Re(ngeralion <br /> Grease Irap Woodstove <br /> Rool drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby certlfy Ihal I have read and exammed ihis applicaUon and know the same to be true and coned. All piovrsions ot laws and <br /> ordinances goveming this type of work wdl be complied wdh whether specfied herein or nol. The granting of a pertnit does nol presume <br /> to grve authonty to viotate or cancel lhe provision of any other state or lowl law regulating construdion or the performance o1 <br /> conslruction. Thal I am authorrzed by the owner ol this property to perlorm the work for which application is made and I comply with the <br /> State Contraclors Law 18 27 RCW and 296 200 WAC. <br /> ;�� /o <br /> S�gnature ol OwnedCoNractodAuthor¢ed Agent Date i/ <br /> Z <br />