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��RMIT APPLICATICrN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �� �� � <br /> 425-257-8810 — FAX 425-257-8857 —www.everetb.va.oro <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PE MIT# <br /> / , • , 3/z o 0o y ov ('�' -� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. I I CJ�/�1i3£R�y <br /> OWNER ADDRE�S CITY2IP PHONE <br /> �9�� ��/PKCl��'�'k 11.L f.'G�/,�OX `j/O C�/-VTo�t/ 9813G 3��^-3y/-�/Ge`l <br /> TENANT NAME CONTAC7 FOR PERMIT PHONE <br /> I ��'/,'R y D��.v .3Go- 9�9- �933 <br /> CONTRACTOR A�DRESS CITY2IP PHONE <br /> •/�9`Uf/��PkCRtEk G� c <br /> CONTR.LICENSE# <br /> PR.Pk ��aro/ Z�13 /?v./.��'x �1/D CU.vicN 98�3G 3G� -3y/-yGoy <br /> USE OF BUILOING I HEAT SOURCE � CONTRACT PRICE OF WORK <br /> S/vGLzf�MiCY DuJ£LLIiUG —Electrir. X Gas_Other �/y noo <br /> WORK DESCRIPTION <br /> CON.STRUCTo9 NE �� SIA�GLF f=A:'�/L y QWFL L/ivG- <br /> A� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF F!XTURE OR ITEM <br /> � Toilet A/C—air handling units <br /> � Bathtub / Forced air systems <br /> j�_ Lavatory(wash basin) � G,s piping <br /> ' Shower �_ Water heater <br /> � Kitchen sink&disposal � G�s fireplace <br /> � Dishwasher _� Gas range <br /> � Clolhes washer � Clolhes dryer <br /> _ Laundry tray � Range hood <br /> Sink (service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> � Floor d�ain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> I <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> II hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> � ordinaces goveming this rype of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> ; to give authonty to violate or cancel the provision of any olher state or lacal law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> � Slate C�ctors Law 18.27 � ,�'d 296.200 WAC. <br /> ���%��.�"�'`� y-x.�7_vs- <br /> iSignature of OwneriCon ractonAulhorized Agent Date % <br /> I <br /> I <br />