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i ------- --------� <br /> � :RMIT APPLICATI� ,� <br /> ' CITY OF EVERETT PERMIT SERVICES ' <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org J� --1� �-!(7 <br /> APPLICATIONS ARE ACCEr'TED FROM 8 AM TO 4 PM �/%1u�-ZCl) <br /> � <br /> SITE ADDRESS �� �' PARCEL TAX I.D. # PE M # <br /> � ' �1,�t-D/D <br /> ?3�'� i�,����1, P��G ��1 �3t:+.. , — <br /> LEGAL LOT NO. BLOCK� � TRACT OR SUBDIVISION N <br /> OESC. �=�� — <br /> OWNER — ��- -�- - � ADDRFSS CITY/ZIP PHONE (�•,��_�t�c�+_Z31Z <br /> I <br /> i ly � -� '7imv i� i r a ��I r'_•,,,�T � <br /> TENAN� <br /> CONTACTFORPERMITL PHONE 7_53-j{S�-CC3c <br /> �eY 2$') '�5�'37S�Z <br /> �'o�i�.,� (��Ort� E-MAIL <br /> �''� � ���� , �� ADDRESS CITYIZIP PHONE <br /> C NTRACTOR <br /> C�.�:y 1,��U� '�nt- P.0 S�CT 23`j 7 <br /> CONTR.LICENSE# . �_.� '���. ��335 Z�3 "�SI-���%U <br /> � FIG,���r x�,,.�ic5 �' :, �t. ' � <br /> USE OF BUILDING , HEAT SOURCE I CONTRACT PRICE OF WORK <br /> r"°.^r.^•`�,.`. �': :•,''I ''�o�'- Elertric _Gas Other }� �' ���'n <br /> � — — <br /> � � 't� 5��= <br /> WORKDESCRIPTION � „n�.I—r SY��'��. <br /> I',n :n{ y..�fir;7,A.nY '�",, � ,�', <br /> �� 1 �j. �,.ti h<��t- k-., ;,�����;_ , S� � <br /> PLUIVIBING MECHANICAL <br /> TYP[OF fIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> NO. — <br /> — A/C-air handling units <br /> _ �ioilet Porced air systems <br /> Bath:ub Gas piping <br /> I_avalory (wash basin) — Water heater <br /> _ Shower Gasfreplace <br /> _ Kitchen sink 8 disposal Gas range <br /> I _ Crshwasher _ Clolhes dryer <br /> , _ Cluthes washer Range hood <br />� — Walerheater - Exhaustfan <br /> Sink {service/badmop/elc,) Heat pump <br /> Back�ow preven�er Unil heater <br /> Urinal Boiler <br /> i _ Drinking Founiain Retrigeralion <br /> ' Floor drein Woodstoo�e <br /> I' � Grease lrap — Olher <br /> i _ Roof drains — <br /> Other _ — <br /> i��, � CRY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> .I I hereby certify lhat I have read and examined this application anA know lhe same to be lrue and correcL All provisions ot laws and <br /> i ordinances goveming this fype af work will be complied with whether specified herein or nol.The granting o(a permit does no;presume <br /> to give authority to vioiate or cancel tfie provision of any otter state or local law regulaling construclion or the periormance of <br /> consiruction.7hat I am aulhorized by the owner of lhis property to pertorm ihe work(or whicn applicati�n is made and I comply with the <br /> �I State CoMractors�827 RCW and 296200 WAC. <br /> 6 Lf— 2S- ]��� <br /> i ;iyna ur�of OwnedConhaclor/Aulhorized Agenl Date (�Z <br />