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P�RMIT APPLICATIOnI <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 -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.A RMIT/ <br /> 130,� Ru��,z A� E- �SD�-do' <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE33 CITY21p PMONE <br /> (VIA��< C'INNNI/.lC� 13�� R��,�R A�. 1=���-� W� q82o1 <br /> TENAN7NAME I CONTACTFORPERMIT PHONE <br /> CON7RACTOR RotIC OF A�tS ��K^�3!,,�!��DRESS �J� �x �-TV CITY2IP PHONE <br /> 7 S.aLTAnI <br /> CONTR.UCENSE+1 � 3�b-�'95-37,�2 <br /> (2ocacAPL `i83 f35 wA q8�9'F <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �[� �p�riqL(�„�c�� FaMi�Y _ElecMc _Gas_Other <br /> WORK DESCRIPTION <br /> lZc�ovE� �C'(-�.�o) (SAn�Ruon�S <br /> PLUMBING MECHANICAL <br /> NO, TYPE OF FIXTURE OR ITEM NO. TYpE OF FI%7URE OR ITEM <br /> Toilet A/C–air handling units <br /> � Balhtub _ Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Showor Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas rango <br /> _ Clolhes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mop/etc.) Exhaustfan <br /> _ Backflow preventer Heat pump <br /> _ Unnal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floordrain Refrigeration <br /> _ Grease lrap Woodstove <br /> Roof drains Olher <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 7105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be compiied with whelher specified herein ar not.The granting of a pertnil does not presume <br /> to give aulhority to violate or cancel the provision oi any other state or local law regulatlng construcdon or the performance of <br /> constructlo That I am authorized by the owner of this property to perform the work for which applicatlon is made and I comply with the <br /> State Co ctors Law 18.27 RCW and 296.200 WAC. <br /> l��� a <br /> Si at of OwnedContrectodAuthonzed Agent Date <br />