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F-cRMIT APPLIGATIuN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evetettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO a PM <br />SITE ADDRESS <br />PARCEL TAX I.D. p <br />PERMIT fi <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION 0 <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />STEPHeA) GRo,;,;mar1 //sA got, St,Sw E-velefl <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />� L NNCA) C R0$S%lQh <br />OWA(•� E-MAIL <br />PYyFlritd couls�Jvc�ro�1 �5is5 rNt 81hsf de�ewN� yZsaBo-8iY,3 <br />CONTR. LICENSE 0 <br />PYRAM4&g161RG C _ <br />USE OF BUILDING <br />HEAT SOURCE <br />CONT C RICE OF WORK <br />Electric _ Gcs _ Other <br />WORKDESCRIPTION Reaper rodad µQCK, <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash Davin) <br />Gas piping <br />Shower <br />_ <br />_ <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boller <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied with whether specified herein or not The granting of n permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating constrrcion 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 />State Contr��actorwl f w 18.27 RCW and 296.200 WAC. <br />s�� �, -x-•sue-c_ vI -.�l - <br />Signature of Owner/Contra for/Authorized Agent Date <br />