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P� :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.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS SPD-'I PARCEL TAX I.D.11 PERMIT# <br /> D f1e� A/e (;—I2'r c.�l" ����Z� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> io 2al�P�e IPr � e�ede ' o� i �o-�o-�o�µ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � E-MAIL <br /> N �\/ � <br /> M � <br /> CONTR.LICENSE N <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Etectric Gas�Other <br /> WORK DESCRIPTION <br /> �e�cc. CG�hi,1ti�+ a COuvt�Cr �(iA. <br /> "�,��,LL�mb .5�wl�- � �txvl•ia,,a�•l�r N� S�-i,u e�Fu rcLP w� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> 6athlub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> � Kilchen sink 6 disposal _ Gas frepiace <br /> _J__ Dishwasher _ Gas range <br /> Clolhes washer _ Clothes dryer <br /> Waler heater Range hood <br /> Sink (service/bar/mop/etc.) _ Exhaust fan <br /> 6ack0ow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiier <br /> Floor drain _ Refrigeration <br /> Grease irap _ Woodstove <br /> Roof drains Other <br /> Olher — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certi(y Ihal I have read and examined Ihis application and know lhe same to be true and correct. All provisions of laws and <br /> ordinances goveming this type of work will be complied wilh whelher specified herein or not.The granling of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating consiruction or the peAormance ot <br /> construc�ion.Thal I am authorized by the owner of this property to perform the work for which application is made and 1 comply with the <br /> • Sta Conlractor Law 18.27 RCW and 296200 WAC. <br /> ��cL� J � IRn.�� � ��'-,'— ic� <br /> Signature of OwnedConiracrod ulhorized Agenl Date <br />