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f =RMIT APPLICATI.�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.# PERMIT M <br /> / / //cz -�� ���L���`7� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION It <br /> DESC. <br /> OWNER ADDRES�!S CITY/ZIP PHONE � <br /> ` /.l �� �(i ' /1 ./ �Z�� <br /> lI�?GP� >y7(� — cY7 — l��e �(.�� fGl76�G.. !,f���rJ 33r -Sd/� I <br /> TENANTNAME CONTACTFORPERMIT PHONE I <br /> E•MAIL <br /> N DR � <br /> CONTR.LICENSE It ��,�J�/�/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> j �-�� _Electric _Gas_Other <br /> WORK DESCRIPTION � / <br /> ��ls�� / / ti-� /�/�G� �"'� '�'U/ �Q��I M �l� <br /> ��� C° �O�oS -0�3 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> 6athtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler heater Ra�ge hood <br /> Sink (service/barhnop/etc.) _ Exhaust Fan <br /> Backllow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease irap _ Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL 5ALE5 TAX CODE IS 3105 <br /> I hereby certify ihat I have read and examined this application and know ihe same to be true and correct. All provisions of laws and <br /> ordinances governing this rype of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give ailthoriry lo violal or cance�lhe provision of any other stale or local law regulating conslruction or the periormance of <br /> conslr�iclion.That I am a horizeflby ihe owner of this property to perform�he work for which application is made and I comply wilh the <br /> Stat�ContraClnrS�La . R and 296200 WAC. <br /> �� j/�!� •, /J � <br /> �� . .�1:.� ��:� � i/ 1�� ��f�Cll U <br /> ig g ure of Ow eF onlraclodAut or¢ed Agent Date <br /> .._-� <br />