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a :RMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA Q8201 <br /> 42i-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 5 �l( �/(/ <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT� <br /> i`1 tb �'t�.�1tLcJ�t� �pK �go�lv2c��oo�'co ' -r�- <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> ONMER ADDRESS CITY2IP PHONE <br /> N-�c� C�,rv--cc� 1�1� S Ltt� 2?31� 2�-,�. ��� 5� E��.dl g$ta�t <br /> TENANTNAME CONTACTFORPERMIT PHONE 3�p -[,��''�ZZL\ <br /> 11JT�'►'` U-Ci I �c.-� (�(t <br /> � S E-MAIL <br /> / <br /> NG'�TKW eST 1�1Urrw'� tf�,� �/lt �nJc— 3bD • bS3 -772�\ <br /> CONTR.LICENSE# NwP�bSS � 3&lb LI,b4G• P[ u��Z7 �'�t���- Y��3 <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric _Gas_Other <br /> WORK DESCRIPT�ON p 1 , �„np� ��. .���.L S(✓2�S <br /> �G Fc�nYOc � ta�Z b C cc.� (ZOUu^ �.r�r< <br /> �G�OGfiT[cn^ O� �OY1•L�'KS <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC–air handling units <br /> Bathlub _ Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clo�hes dryer <br /> � Water healer = Range hood <br /> Sink(servicelbadmop/etc.) Exhaust han <br /> Backilow prevenler _ Heat pump <br /> Urinal Unit heater <br /> �_ Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> �_ 4.,�mn I �s/I-� — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9106 <br /> I hereby certify lhat I have read and examined this application and know ihe same lo be true and correct. All provisions of laws and <br /> ordinances governing this type of work wili be complied with whether specified herein er nol.The gran6ng of a pertnil does not presume <br /> lo give authority to violale or cancel the provision of any other state or local law regulati�g conslruction or lhe pertormance of <br /> construction.That I am authorized by the owner o(this property to perform the work for which application is made and 1 comply with ihe <br /> Stale Contra'ct�s Law 18.27 RCW and 296.200 WAC. <br /> /Sr� /4 �H s s-1 Z� rU <br /> Signature of OwnedContractod uthonzed Agent Dale <br />