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PC 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 ADDRE33 PARCEL TAX I.D./ PERMIT# <br /> "S �� OD�a-Gb� <br /> LEGA l0T NO. BLOCK TRACT OR SUBDMSION• <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> s`�ie� �a����„� 350� S�a�� �ve F:��r�( y1S'-yzz-�o � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I �G�iVI 'eiL E-MAIL <br /> CONTR.LICENSEM �/6� <br /> G <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas_Other ��j��L� <br /> WORK DESCRIPTION <br /> iL%� co%���Q �ao��G, � p��`o — <br /> � 3�y <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _, A/C—eir handling units <br /> BatMub _ Forced atr systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kitchen sink&disposal _ Ges fireplece <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clolhes dryer <br /> Water healer _ Range hood <br /> Sink(service/badmop/etc.) _ Ezheust fan <br /> Backtiow prevenler _ Heat pump <br /> Urinal _ Unil heater <br /> _ Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof dreins _ Other _ <br /> Other — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE�S]106 <br /> I hereby certity that I have read and examined lhis application and know the tame to be irue and corred. All provisions of laws and <br /> ordinances governing this type of work will be complied with whelher specified herein or not.The granting of a pertnit does not presume <br /> to give authority to vidate or cancel lhe provision af any olher state or local law regulating conskuction or the performance of <br /> construction.Thal I am authorized by the owner of this property to perform the work for which application is made and I comply with lhe <br /> State Con ctars Law 18.27 RCW and 296.200 WAC. <br /> � ���� ���1�1U � <br /> ` gnaturey wn ACont adAuth Dete / <br /> � <br />