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Ps.RMIT APPLICATIGN <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 - DEBIT&CREDIT CARDS ARE NOT A EPTED <br /> SITE ADARES PARCEL TAX I,D.7! <br /> .1 ` AffRM: ITp <br /> LEGA LO 0. BLOCK TRACT <br /> OWNER - 1 Com 12u Z - all - C)-3 <br /> ADDRESS CITY/ZIP <br /> PHONE -- .77-1 <br /> � �)!n�(,:. C•i �11d1^ ' "- l (!71 <br /> TENANT NAME it 'tiI J(v <br /> CONTACT FOR PERMIT PHONE <br /> CONTRACTOR <br /> ADDRESS , <br /> CITY/ZIP PHONE <br /> CONTR.LICENSE p '• - i , <br /> ��C1 C f1 'I2 ►-� T ''� rj " ' /" <br /> USE OF BUILDING HEAT SOURCE <br /> CONTRACT PRICE OF WORK <br /> lic- {-�) _Electric �GQs—Olher <br /> WORK DESCRIPTION <br /> PLUMBING <br /> MECHANICAL <br /> N0, TYPE OF FIXTURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> �L Totiol <br /> _ Balhlub A/C-air handling units <br /> Lavatory(wash basin) = Forced air systems <br /> Shower ¢ -Y Gas piping <br /> 1�: Kitchen sink 8 disposal % Water heater <br /> _ Dishwasher —I Gas fireplace <br /> Clothes washer Gas range <br /> Laundry tray Clothes dryer <br /> Sink(service/bar/mop/etc.) ! Range hood <br /> Backtiow preventer ._,Y! Exhaust fan <br /> Urinal Heat pump <br /> Drinking Fountain Unit healer <br /> _ Floor drain Boiler <br /> Grease trap Refrigerilion <br /> Roof drains _ Woodslove <br /> Other _ Other_ <br /> CITY CF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceritify that I hay a road and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinates governing 1111.4 IYUe of work will be complied with whether spa Aod herein or not.The granting of a permit does not presume <br /> to give authority h,vi lale or cancel the provision of any other slate or local law regulating construction or the performance of <br /> construction.Thal I am authorized by the owner of this property to perform he work r which application is made and I comply with the <br /> Stale Co tractors Law 16.27 <br /> 'CW <br /> and 296.200 WAC. _ <br /> Signature o caner antra orlAulhonzed f 1 <br /> - - _ gent —�. ate <br /> A>e a/fid <br />