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6�-n e��- .h o S'o� ;� � <br /> _ <br /> p "RMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857—wuvw.everE�ttwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PER T# / <br /> /1�.3�3 /yfh it �` 5� , <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE � <br /> 1 <br /> � <br /> TENANT NAME CONTACT POR PERMIT PHONE . <br /> �iL 1�i��//�Gj�JI� I ��-�� .�-� /�yf/970 <br /> CONTRACTOR�VI'GJ L`7V��%''� ADDRESS /O,�/ CP a� CITYIZIP PHONE <br /> f+'/�= �v1a,✓ySw(lc �loU ,�.�� a <br /> CONTR.LICENSE#�/�'�,_I�nl�c 9�S N G W�- �f��U `7 �/� � <br /> USE OF�UILDING HEAT SOURCE CONTRACT PRICE OF WORK ; <br /> � <br /> ���/�P� _Electric _Gas_Other /S�� 9 <br /> i � <br /> WORKDESCRIPTION yj}'�� �I �'j'Jro /�� � <br /> ` " r <br /> IL�CG v��I ' f <br /> PLUMBING MECHANICAL j <br /> � <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> �_ Toilet _ AIC—airhandlingunils <br /> Bathtub _ Forced air systems <br /> J-� Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> � Clothes washer _ Clothes dryer <br /> Laundry tray _ Range hood <br /> � Sink(service/badmop/etc.) r,U _ Exhaust tan I <br /> Backflow prevenler / V _ Heat pump <br /> Urinal /` {�1 � _ Unit heater <br /> Drinking Fountain /�1•J _ Boiter <br /> � Floor drain I � � _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> !Z/' -1 �--'� <br /> CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> I hereby ceritity lhat f have read and examined this application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified heroin or not.The granting of a pertnit does not presume <br /> to give authority to violale or cancel the provision of any other state or local law regulating construcQon or the performance of <br /> constructior..That I am authorized by the owner of this property to perfortn the work for which applicaUon is made and I comply with the <br /> State Conlractor Law,18 27 RCW and 296200 WAC. <br /> � �-�'�� <br /> Signature o wn dCo t ctodAuthorized Agent Date <br /> t <br /> � <br />