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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 8 AM TO 4 PM G -as- 07 <br /> SI7'E ADDRESS PARCEL TAX I.D.# PERMIT t� <br /> � D c�5 ,Aa(c; ' <br /> LEGAL LOTNO. BLOCK TRACTORSUBDIVISIONN <br /> OESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE Zp6 l.J�7 ¢j��S <br /> �(GS l�.�S i'61 R+�H� �iQ c�c� L cri.�c-� <br /> Ea+IAIL <br /> �(cw-Gv,�.�.,� wt�c��^c- (.� 8�(� 4����-N� S�+- `��?t�s �a�s�� 8s�� <br /> CONTR.LICENSE# <br /> e1 ��'Y► l�� ��LI ��D�l(� O� <br /> USE OF BUILDING HEAT SOUR E CONTRACT PRICE OF WORK <br /> Electric �as Olher <br /> WORK DESCRIPTION <br /> Add u� i�1 ���� •; B�� -I-� 5��� <br /> C--v��� -1� l��-� � �-c-..� 1�.�,� �z��.S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A!C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower ,� Water healer <br /> � Kitchen sink 8 disposal _ Gas fireptace <br /> _L Dishwasher _ Gas range <br /> Clothes washer Clothes dryer <br /> I Waler heater Range hood <br /> �C Sink(service/bar/mop/etc.) Exhaust tan <br /> ( Backflow prevenler Heal pump <br /> Urinal Unil healer <br /> Drinking Founlain Bailer <br /> � Floor drain _ Reirigeralion <br /> Grease trep � Woodslove <br /> Roo(drains Other <br /> � Olher F<<<��L 5��.�G ,i �� C� <br /> .l i c' M.1-�1'1c"� <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceriti(y Ihal I have read and examined this application and know lhe same to be lrue and correct. All provisions ot laws and <br /> ordinaces c�oveming lhis type of work will be complied with whether specified herein or not.The grenting of a permit does not presume <br /> to give aulhonty to violate or cancel the provision of any other state or local faw regulating conslruclion or the performance of <br /> construction. That I am aulhori�ed by the owner of this property to peAorm the work for which applicalion is made and I comply wilh lhe <br /> State Conlr ors Law 18.27 RCW and 296.200 WAC. <br /> �� �' -2�-0 <br /> Sign e o(Ow r ontrac or/Aulhorized Agent Date <br />