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PEKMIT APPLICATIOIv <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 3 � �5� D� <br /> SITE ADDRESS PARCEL TAX I.D.# RMIT# <br /> � ; <<� �<«�, �a�� s� �o-� b3- <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS CITYlZIP PHONE <br /> I��a')a�1�E�1.� le ' �oi�ti�c_��1� <br /> ET NANTNAME CONTACTFORPERMIT PHONE <br /> _f i_�.� "[- �1�t� n�eXic��i� �.�v 11��, 1.�1�, �� S ��,�-�5�3 ��1�� <br /> CONTRACTOR ADDRESS CITYIZIP PNONE <br /> ,vcrZ i(-i wcs-c l�l�wv�o v��1�.:r�i � <br /> CONTR.UCENSE# C,iy�a � <br /> ? (� l . �rl (� !v� 1 3 � r n t�l ro y�.n�- <br /> USE OF BUILDING I — HEAT SUURCE CONTRACT PRICE OF WORK <br /> Electric _Gas Olher <br /> n�EK�cc �� C� cor _ <br /> WORK DESCRIPTION <br /> �C_V1,t a)G, ��C�SCJ �1 �' . � �l !�1 L�v��� ��-q. <br /> PLUMBING MECH NICAL <br /> NO. TYPE OF FIXTURE OR ITEIN N0. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handling units <br /> Balhlub _ Forced air systems I <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clolhes dryer <br /> Waler heater _ Range hood <br /> � Sink(service/bar/mop/etc.) _ Exhaust tan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodslove <br /> Roo(drains _ Other <br /> Olher — — <br /> CITY OF EV�RETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerili(y Ihal I have read and examined this application and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces 9oveming this type of work will be complied with whether specified herein or not.The granling of a permit does not presume <br /> lo give authority lo violale or cancel the provision of any other siale or local law regulaling conslruction or the performance of <br /> construction.Thal I am authorized by lhe owner oi Ihis property to perform lhe work for which application is made and I comply with lhe <br /> Slale Contrac�s Law 18.27 RCW and 296.200 WAC. <br /> // �� L�< <un S 3 �� t —G7 <br /> SignaWre of wnedConlraclodAuthor¢ed Ac�ent Dale <br />