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{ cRMIT APPLICAT�../N . <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 <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT N <br /> � CI� '� e � <br /> LE A LOT N0. BIOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> ONTIER ADDRESS CITYIZIP PHONE <br /> ���t �Niv�'O/�9 J�.z`� Cnl� f'✓¢rEf� ���0 ���C — �� <br /> TENANTNAME CONTACTFORPE MIT PHONE <br /> /'� y1S �G� �Sf/ <br /> / � �/ � <br /> (� f/MT'1— _ IONY _�G--�IN�ML � E•MAIL Iw+v.�Ak1Q.�✓!�l�Gf-C iv/ <br /> ADDqES$ <br /> Awlz , ;�� pv�x �i2 � v�wys�,����, �r� �z�.3� � �ssi <br /> CONTR.UCENSE N /IwQ1��. ,� 9E Z R S <br /> r� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> i <br /> m��`,� / ���A! ��`�i.« _Electric �j Gas_Other ��DG �o <br /> WORK DESCRIPTION / �_ r <br /> �l'Is�Jy�� �. /1L'i� C��i > ��./Vl'�e p�PC f �OwT �C7�� 7 O L'X/f•�� n� <br /> r�^✓ ✓��LGi. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FU;TURE OR ITEM NO. TYpE OF FIXTURE OR ITEM <br />� _ Toilel A/C–air handling uni�s <br /> _ Balhtub Forced air systems <br /> _ Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> _ Kdchen sink 6 disposal Gas tiieplace <br /> __ Dishwasher Gasrange <br /> _ Clothes washer Clothes dryer . <br /> _ Water healer Range hood <br /> Sink (servicelbadmop/etc.) Exhaust fan <br /> _ �ackilow prevenler Heat pump <br /> Urinal Unit hea�er <br /> Drinking Founlain Boiler <br /> _ Ploor drain Refngeration <br /> Grease irap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby certify that�have read and examined this application and know the same to be true and correq. All provisions ot laws and <br /> ordinances governing this type of work will be complied with whether specified herein or noL The granting oi a pertnit dces not presume <br /> to give authority to violate or cancel the provision ol any other state or local law regulating constn�dion or the performance oi <br /> constructio�. That 1 am autho i$ed by the owner ol this property to perlorm the work for which application is made and I comply with ihe <br /> State Cor�fr aors Law 7827 RCW and 29�200 W�C. <br /> �/� Z/ ; //(7 <br /> Sigqdtur. oPOwner t dAuQiorized Agent a <br />