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��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.N PERMIT A �/ <br /> LEGA LOT NO. B�OCK TRACT OR SUBDIVISION k <br /> DESC. <br /> OWNER� � ` _ �.� �� �DRESS CITY2IP PNONE <br /> KC/C9v 1 <br /> v�f�� I ' • <br /> TENAN AME CONTACiFORPERMIT PHONE <br /> I �(.c7i e '-�'�ILCC'�. E�ANL ��r1.�o� ' �I10� <br /> L�6FTtFAC'Fd p W N r�R <br /> CONTR.LICENSE If <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric _Gas_Cther <br /> D�i ,oJ <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIX7URE OR I'(EM NO. TYPE OF FD(iURE OR ITEM <br /> Toilet AIC–air handling unils <br /> Bathlub � Forcedairsystems Wi�( 9� n„__,L �__/ <br /> — Gas piping /–"•^ •`�'�" <br /> _ Lavalory(wash basin) Water heater �`, skb <br /> _ Shower Gas fireplace ���, . <br /> _ Kitchen sink 8 disposai Gas range <br /> _ Dishwasher Clolhes dryer <br /> _ Clothes washer Range hood <br /> Water healer — Exhaust fan <br /> _ Sink(service/barlmopletc.) Heat pump <br /> _ Backflow prevenler — Unit healer <br /> _ Urinal — goiler <br /> _ Drinking Fountain — Refrigeretion <br /> _ Floor drain — yy�stove <br /> Grease lrap Other <br /> Roof drains — <br /> Other — ' <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity thal I have read and ezamined this application and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces governing lhis type of work will be complied wilh whether specified herein or nat.The granling of a permit daes not presume <br /> to give aulhority to violate or cancel Ihe provision oi any olher stale or local law regulaling wnslruclian or ihe periormance o( <br /> construclion.Thal I am authorized by the owner of this property to periortn the work(or which applicalion Is made and I comply with the <br /> Slale Coyr�ctors t,ayv 18.27 RCW and 296.200 WAC. <br /> �L� � � d <br /> J�� iv0�'q/�QS�-- � <br /> Signature of Owner/Contra orlAuthonzed Agent 1 ^ ,Date /� <br /> � <br />