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SITE ADDRESS <br />. �� <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />� ' . <br />'1 ` � � i i� <br />TENANT NAME <br />���-r � <br />CONTRACTO! <br />CONTR. LICENSE # <br />USE OF BUILDING <br />cRMIT APPLIC�4T�N <br />� <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 />I PARCEL TAX I.D. # <br />i' �-- i 1 . <br />TRACT OR SUBDIVISION # <br />ADDRESS <br />, _�� ., � � `.`.� 'C�: ; �� .Jc: ��; <br />I CONTACT FOR PERMIT <br />WORK DESCRIPTION y <br />� � ` � C �. i% <br />HEAT SOURCE <br />� Electric _ Gas _ Other <br />`-/�Ll� �JC�L/�'�/ <br />_S � �� (._ C� � � �r l� /7�� c , S � <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />I Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO <br />=RMIT # <br />�� ! /1/7i _ <br />ricir rnvrvt ���7-• <br />I ,� J� <br />�` /,'._ �,5 r:. � j�� �' lt.L � `S� <br />PHONE <br />�.�� j `l � � - l'° � �� <br />E-MAIL <br />CONTRACT PRICE OF WORK <br />'-I"� �i Y�l 5 ��(JN 1 � <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other /)F�;.���; <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 />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 Contrac�tors Law 18.27 RCW �nd 296.200 WAC. <br />/ , <br />/%7 ,-, �'--- �, � _/ S l�i <br />Signa <br />