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� <br /> RMIT APPLICATI�`iN <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 /> APPLICATIQNS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 1 `�1 -\�ti,. l�.r,,v.v� 4 pl�o - oG �/0o � 51G�1- �o -�i <br /> LEGA LOTN9. BLOCK TRACT <br /> DESC. <br /> OWNER �j�/ClA J ,(3U�N//A// /�U/SS�X /393 Cl/���N/l PHONE <br /> SKoTa�It .�'voc.��l,c�' ri?us f �L/�s/ /9ni ,�� ���� �`vr,rr�;r <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 5�,,,.C�ots-t �rahh�,.,� Ua�C.2,.�1 C��s� 3�a-SayH <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> f��110 I�i�,'t,�.c. �t�a� Fiz���,- .�la�c�r;�ttc ��>h M�k��ifo aga�s L��as)3H�i -SaH�t <br /> C NTR.LICENSE# <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> C.^.'rMY��;rCt�� I Electric Gas Other ,� ���UU `"' <br /> WORKDESCRIPTION ��yI� -�IlU�r1r2't4i,� 1�trS4.� Ov� 6"�rZ�+ ��Ct� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toile� A/C—air handling unils <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> � Shower Walerheater <br /> , Kitchen sink&disposai Gas fireplace <br /> Dishwashcr Gas range <br /> Clolhes washer Cbthes dryer <br /> Water heater Range hood <br /> Sin4(service/badmop/elc.) Exhaust fan <br /> Backflow preventer Heatpump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> � Grease trap Woodstove <br /> Roof drains Olher <br /> Olher <br /> ` CITY OF EVERETT LOCAL SAI.ES TAl(CODE IS 3105 <br /> i I hereby ceritiry that I have read and examined this applicalion and know the same to be true and cortect. All provisions of laws and <br /> ordinaces governing this type of work will be complied wifh whelher specified herein or not.The grantlng of a pertnit does not presume <br /> to give authority to violale or cancel the provision of any other state or local law regulaGng construction or the performance of <br /> construction.That I am authorized by the owner of this property to pertorm the worlc for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> ��M,�. C-�C,��1 7"/i-/U (� <br /> Signature o(Owner/Co�ltractor/Aulhorized Agent Date <br />