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._ . ,.�� , ._ _,, . -.._,, . � <br />SITE AODRESS <br />�� �C <br />LEGAL L� T N0. <br />DESC <br />PERMIT 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 <br />BLOCv TRACT <br />PARCEL TAX I.D. N <br />iRM1T N <br />_' � 1..��. �- <br />'�\��Q Co2�P �a.0 �20��.��\� �.��� q�"LO� <br />TENIUIT NAME �� LCON7ACT FOR PERMR (�ry � PHONE <br />� \v�kQ. I�.F�-QQ\rc�Q\ � aa-�-- \4�C� <br />CONTRACTOR ' • ADD F56 CITY2IP P ONE <br />�c�e��cQ,r�%c�`�r�cc� 4y.O.��c \\3�� �"Z--Ov`�' <br />C,NTR.'MCS7 \ CY'�C' Cl'��g� \���QCQ i�J �� 0��� �� 41 <br />OF BUIL ING • HEAT SOURCE <br />�� � � U��� � Eloclnc Ges Other <br />� r.,,., � — — <br />WORK DESCRIPTION <br />'��cs�� o� �c �S� � ��C� <br />��•�c�m <br />m uluo��ir_ <br />NO. I TYPE OF FIXTURE OR ITFM <br />Toilet <br />Bathtub <br />Lavelory (wash basin) <br />Shawer <br />Kitchen sink 8 disposal <br />Diehwesher <br />Clothxs weshar <br />Laundry tray <br />Sink (service/borlmop�etc.) <br />Backllow preventor <br />Urinal <br />Drinking Founlain <br />Floor drein <br />Grease hap <br />Roof drafns <br />Other . . _ _ _ _ <br />CONTRACT PRICE OF WORK <br />� a.a ,�OS <br />MCCHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ NC — alr hentlling unAs <br />Forced air syslems <br />Gas piping <br />Weter hnater <br />Gn5 �rapince <br />Gas rnnge <br />__ CIOIIlO5�fY0f <br />Rangehocd <br />Exha�st tan <br />Heal oump <br />Unit heal�r <br />Boiier <br />Reinge�a�ion <br />Woodslove <br />Other <br />CI OF EVERETT LOLAL SALES TA% CODE IS J105 <br />I hereby eoritify Ihat I have read and examined Ihis applicalion and know ihe same to ne tr�e and conect. Ali provisons ol laws and <br />ordinacos yooern�ng this type ol work w�ll be complied wilh whether speciGed herein or �ot The grenung ol u pennit does not presume <br />to grve euthority to violale or col the prnvisron of any olher slate or �.�I law re9ulabng constr�nion or Ihe Dadormance ol <br />constructimi. That I am a or cd by Ih w r o ihiy proper�y �o pe�urm Ihe work lor whica apD'��aCron is medB and I Comply with the <br />Slatn Cnqtrador4 Law 27 CW an�� 200 AC. � � <br />