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F :RMIT APPLICATIvN <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98'101 <br /> 425-257-8810—FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �,' � UL(� -C�7� <br /> SITE ADDRE33 ' � PARCEL TAX I.D.# PERMIT M <br /> f� � �� S � �---�-i � . C, <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER � ADORESS CITYIZIP PHONE �,'%� <br /> /� ( �� I1 �O �� �n�l �f ( 7" � �� � � .�l/�l�'S l-�U�L� ���i�-O� �i��.u` '� <br /> TENANT NAME CONT CT FOR PE IT �P ONE��'� !�/ ���i <br /> � B E�-�y <br /> � . l� E_ �6 � -� �' r�t�... � . AIL <br /> D � L �� <br /> � � � T <br /> CONTR.LICENSE M V �O�`1 C� Q � � C L�� r-� � I <br /> Loti., � Y �C�'o-('� <br /> USE OF BUILDING HEAT SOURCE CONTFtACT PRICE OF�W�K�� <br /> � � <br /> �/Jr � �� � _Eleciric �Gas_Olher ,���� <br /> WORK DESCRIPTION � - <br /> ��,r,� '+'� � , v,. (�� c;s � , ��, ,�� , <br /> d� <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM — <br /> Toilet __ A/C–air ha�dling units <br /> Bathlub Forced alr systems <br /> Lavalory(wash basin) / Gas piping <br /> Shower � Waler healar <br /> Kitchen sink 8 disposal _ Ges lraplaca <br /> Dishwasher _ Gasrange <br /> Clolhes washer _ Clolhes dryer <br /> Water heater _ Ranga hood <br /> � Sink (service/bar/mop/etc.) _ Exhaust fan <br /> �_ Oackflow preventer Fleat pump <br /> Urinal � Unit heater <br /> Drinking FouNain _ Boiier <br /> � Floordrain _ Relrigerelion <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 1106 <br /> I hereby certify Ihat 1 have read and examined Ihis application and know the same to be trua and correcl. All provisions ot laws and <br /> ordinances governing Ihis type of work will bo complied with whether specifed herein or not.The grenting of a permit does nol presume <br /> lo give authority lo vidate or cancel the provision of any other state or local law regulaling conslruction or Ihe perlormence ol <br /> cons;ruclion. That I em authorized by the ownor of lhis property to periorm the work(or which epplication is made and I comply wi�h the I <br /> Slale�Co t�aclors Law 18 27 RCW and 296200 WAC. <br /> � , �-� <br /> , I � . <br /> Signatur o wnedContractor/Author¢ed Agent Dale <br /> � <br />