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PCRMIT APPLICATION <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 /` 3 —b b <br /> SITE ADDRESS' — - PARCEL TAX I.D.# RMIT# <br /> '',Z.,:)(-Y; l")0C/D :-.C-g_CIde- ble:601 -C,C77-- <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> - J (C) <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> : - j/Iris e ro0. a 2.No-3510-3oog <br /> Mof+enS <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> • CONTR.LICENSE# -)/� <br /> /1 4;)(-- AS (%-_ <br /> USE OF BUILDING HEAT SOURCE CONT ACT PRICE OF WORK <br /> Electric _ Gas Other (� G-1-6 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toiiet A1C–air handling units <br /> Bathtub Forced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater --- Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ uoiler <br /> __ Floor drain Refrigeration <br /> Grease trapWoodstove <br /> Roof drains Other <br /> y Other <br /> 1 <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 Ictal law regulating construction 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 Contractors Law 18.27 RCW and 296.200 WAC.___Co <br /> Signature of OwneriContractorlAut lorized Agent Date / <br /> �1 <br />