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PtRMIT APPLICATI�N <br /> CITY OF EVERETT FERMIT 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 � ) —O� <br /> SITE ADDR�S PARCEL TAl(I.D.p P O IG/v l_ DD <br /> Z a.•r <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> lD�S Q D D <br /> TENANT NAME G"�NTA T FOR PERMIT PHONEL/.�/�� !2'y� <br /> i1l.S � _ I�t7����7 r��` <br /> e-Ma� <br /> R�cso� �'��� ��( ���E,P.� �25':�757? <br /> TR.LICENS�� � rj��<�y������ <br /> /7K1 / <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'e�P�� _Electric _Gas_Other � ��(9(`j�� <br /> WORK DESCRIPTION <br /> ���e- ���,�y o� ��sr;�y �����y <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel FllC—air handling units <br /> Balhlub Forced air systems <br /> � Lavatory(wash basin) �as piping <br /> Shower Waler healer <br /> � Kitchen sink 8 disposal Gas Tireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/barlmop/elc.) _ Ezhaust fan <br /> BackOow preventer ' Heal pump <br /> Urinal Ur::�heater <br /> Drinking Founlain Boile; <br /> Floor drain Refriger:tion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerility that I have read and examined this applicalion and know lhe same to be lrue and cortecL 411 provisions of laws and <br /> ordinacr.s governing this type o(work will be complied wilh whelher spocified herein or not.The granling ol•�permil does nol presume <br /> to give authoriry to violate or cancel the provision ol any olher stale or local law regulating construclion or the �edormance of <br /> construGion. That I am aulhorized by the o�ti�ner o(Ihis property lo peAorm the work for which applicalion is made and I comply with the <br /> Stal�e C�itraclors Law 1�27 RCN' and 296.200 4VAC. <br /> c�Q.�,� .9-4'i�c,��taeu� l 2-7-D,� <br /> S'ign�ure o Owner/ on raclodF�ulhonzed Agent Dale <br />