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. i <br /> I <br /> '� RMIT APPLICATI N <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 /> �,2� �aYt�,H,�.�rwr�rr w+� a�zo� ��iRo�t�,00aoo � `�''(���'f <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. o(�lp�l�,�VL�('�t �`�GEG✓ 'I L'�j �t/�f�YT G�'/U1� W� <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> Ci(�"� G� G%l/�G��� �iZcit.V��l/� �G�� �� N�✓r+Y ��l i �Cil/k'�'i.j��W+j'�`bQQ( �?l�! �i'JZ�lY�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE��j �Z. 68R� <br /> ���(iT�Ll���^�vnVG� (�Y�li� �CI� �il�lV��"�f1I� E-MAIL��'UC�fG�(,Fc-I/ <br /> k�f'p',o►�4,U <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> �-��'�E� <br /> CONTR. LICENSE# ��/"C� ,� /� , ,r �I �_� <br /> L / � � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRfCE OF WORK <br /> Li/�10� C�'�1'M,U1UG1'�c' f�iN�(fGt"L Electric �Gas_Other ��M„ �,��"jd�� <br /> WORK DESCRIPTION`fE}'�h �Q�F'tC���n�,u� � ��r� o�nr� �,�r�hruvcc� �nva-�r c�� �� +� <br /> 2���2�1�w M�rt or� �Ff-T�n�ye,N�u�vhc.,�"l{✓-vi ��s, r�r��wei�s�ov oF1t4�,t�NcN� �au ��4� <br /> �a'��6[�l� ��i�r3�k(��hY�T���Tlt�-�u'u �;��k��sc�ll �l��MI�M P�I�v��P�r�� <br /> �-(�1'c.T=�11�ti F(i"�k- <br /> f�kf'C+}e�Mf",A�q`l�I DaD FLD�b��'� � ��ftr¢�f�GEU�.I�w1lCc�h(X�i f�-l��ui@� S,��' MAeI�}uVk� �SPI�+IOk t�.ry�ti� , <br /> PL MBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet '� A/C—air handling units <br /> Bathtub ( Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower J_ Water heater �pt,¢tilt�(��c�hj-�nt� <br /> Kitchen sink&disposal Gas fireplace <br /> l Dishwasher Gas range <br /> � Clothes washer t C es dryer <br /> l ater he /t�eV�YWli� �_ Rang hood <br /> Sink(service/bar/mo etc.) � Exhau t fan <br /> Backflow preventer Heat p mp <br /> Urinal l Unit h ter <br /> Drinking Fountain Boiler <br /> � Floor drain � Refriger ion <br /> 2 Grease trap Woodstov <br /> I Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I 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 governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> const��ction. That I am authorized by the owner oi this property to perform the work for which application is made and I comply with the <br /> $tate Contractors Law 18.27 RCW and 296.200 WAC. <br /> ' � , � � -- �-� �� , j � '�� <br /> Signature of Owner/Contractor/Authorized Agent Date � <br /> _ � �� <br />