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t. <br /> RMIT APPLICATI(:.�I <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 �� ��s <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> l (o = S '�� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��� s`�Qko� a�a� �o��� ��� ���� xZ-s�� <br /> TENANT IJAME CONTA T FOR PERMIT PHONE <br /> ��w� �-akE. �QLI`flhK-� �`c"U �qw �4z5) 25Z- 311�f- <br /> CONTRAC70R ADDRESS CITY2IP PHONE <br /> Ellt26� S-l�4-cc f�F.�4T � ��C 2izo 1�c-��Z. 6�e¢r�t- RSZoc (41 2s2-3riy- <br /> CONTR.LICENSE# <br /> EVCQ�SSo Zz o�- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> RL�. ,�hu2hNT _Electric ZC Gas_Other � �/ S(��.� <br /> WORK DESCRIPTION r <br /> ruw-u� � T�snc-�.� � i� 4rati ��.t W� Dw�T c�otiK G�2.4`s C�s �p�� <br /> , , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet � !VC—airhandlingunits <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryei <br /> Laundry tray Range hood <br /> Sink(service/badmop/etc.) _� Exhaustfan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> _ Grease irap Woodstove <br /> Roof drains Other <br /> _ Other —T � ,�,�_ <br />' CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 II� <br /> I hereby ceritify that I have read and examined this application and know lhe sama ro be true and wrrec!. All provisions of laws and �I <br /> ordinaces governin�this type of work will be complied with whether specified herein or naL The granting of a permit does not presume <br /> to give authority lo violate or cancel the provision of any other stale or local law regulating arsta�coon or the perfortnance of <br /> construction.That I sm authorized by the owner of this property to perfortn the work for which application is made and I comply with the <br /> State Conlractors Law 18.27 RCW and 296.200 WAC. <br /> Signature of OwnedConlractodAuthorized P.gent Date <br /> 1 <br />