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i <br /> ��RMIT APPLICATIUN <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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> _• .` J _ S S� QD // -oo(� <br /> LEGAL LOT NO. i� BLOCK TRACT OR SUBDIVISION!�# <br /> UESC. �2'I C �'�Ot Z£5 (� Hco�J ��tir Ui-J Z <br /> OWNER ADDRESS CITYIZIP PHONE <br /> 7 ' <br /> llh�,�� `��c�P.^� T 2z„ S' S a� �Jc�Z.:T 9k� i yzr zsz-osrN <br /> TENANT NAME CONTACT FOR PERMIT PHONE ��Z� Z�Z.v 3`��� <br /> �K� C�Ci-_V-v'�a-� E-MAIL <br /> CONTRACTOR AD RE I I P NE-- <br /> CONTR.LICENSE# �`(J/�-�� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK I <br /> C� ��nC�G E!ectric _Gas_Other <br /> WORK DESCRIPTION <br /> A� C.�i�� ��lil�!,�L <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilc� AIC-air handling units <br /> Bathtub Forced air syslems <br /> La��atory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kilchen sink 8 disposal Gas fireplace � <br /> Dishwasher Gasrange <br /> Clothes wa,her Clolhes dryer <br /> Water healer Range hood <br /> Sink (service/Gar/mopi�!c.) _ Exhaust fan <br /> Backllow prevenler _ Hoal pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> � Grease lrap _ Woodslove <br /> Roo(drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y thal I have read and examined lhis applicalion and know lhe same to be lrue and wrroct. All provisions of laws and <br /> ordinaces c�oveming this type o(work will be complied with whether speci(ied herein or not.The granting of a permit does nol presume <br /> to give aulhoriry to violale or cancel the provision ef any olher state or local law regulalinc�construclion or ihe performance of <br /> construclion. That I am aulhorized by the owner o(this properly lo pedorm the work for which application is made and I compiy wilh the <br /> Stale Conlractors L��^f'f8.27 RCW and 296.200 WAC. <br /> � ; `:,-- -> r I � �y <br /> Signalure ot OwnedCoNractodAuthorized Agent Date / <br /> '(Z <br />