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FcRMIT APPLICATIuN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 2 `�`p 7 <br /> 425-257-8810— FAX 425-257-8857—www.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �70�—�'�I <br /> SITE ADDRESS , PARCEL ThX I.D.tl ERMIT# <br /> � /� /rf� �NJE O / Z <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHGNE <br /> �-je«� `�nc�.� � cc <br /> TENANT NAME CON�T�A T FOR PERMIT PHONE <br /> �o ye�� n-1��u�'�'��t� �'�iT,� �u���rsoK �zs3�-*�g7> <br /> CONTRACTOR/_ '�^,�'�� m���f _iA/��r �QR�,�' CITV2IP PHONE (�75��–i& <br /> �7 �7�.� �(/ /4�����/jIp�71JI,� � <br /> CONTR.LICENSE#�� ^ - , �_ ^ _, �///� j�'I�p IO�j� GUGWL�-fI�Z23 <br /> /T/y II�I �� F (!A� <br /> USE OF B�J ILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � "�" �g�ey 5�� Electric �C Gas_Other �j�� <br /> �sI�LLO/S — <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> � Toilel A/C–airhandlingunits <br /> Balhtub 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 healer Range hood <br /> = Sink(scrviceNar/mop/etc.) Exhaust(an <br /> Backllow preventer Heat pump <br /> Urinal Unit heater <br /> Drinkinc�Founlain Boiler <br /> Ploor drain Refrigeralion <br /> Grease trap Woodslove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify Ihal I have read and examined ihis application and know lhe same to be We and correct. All provisions of laws and <br /> ordinaces�overning ihis type of work will be complied with whelher specified herein or nol The granling of a pertnit does nol presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulaling conslruction or the performance of <br /> construciion.Thal I am authorized by the owner of Ihis property to perform the work for which application is made and I comply with the <br /> Slate Co Iraclors Law 8.27 RCW and 236.200 WAC. <br /> —�� / <br /> L�l � .�, -f�fl�Jij'���1 Z—/— f1 � <br /> Si�naWre ol Owner Co�odAulhonzed Agenl Dale <br />