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P�MIT 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 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />� 1�� l-i� h la,� d,� <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />�nn N���,� ('��i�e►� <br />TENANT NAME <br />PARCEL TAX I.D. # <br />TRAGT OR SUBDIVISION # <br />AUDFZESS <br />CONTACT FOR PERMIT <br />I��..II� �;��1 <br />GONTRAGTOR ADDRE <br />l�._� L�� �v'�c: � v l, �. t. <br />Pv 5 u �c ? l �1 <br />CONTR. LICENSE # � �� S � � �� ,� �c, `s r, �y � <br />V <br />USE OF BUILDING <br />S F� <br />WORK DESCRIPTION <br />�Z � �1 ��-- � � i � C�. � !"1 J <br />� ri.ti � a <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />l <br />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 drai s _I <br />Other �c:� c�t�'�%t� h <br />HEAT SOURCE <br />Electric Gas Other <br />i ��i ��C l�r�� �' i � �r <br />GITY2IP <br />PERMIT # <br />� �� rs <br />�-1�� ��� - c�:�i�3 <br />PHONE �.�"3 � 0 S'. � �.� I <br />E-MAIL �''�1 C� �� u'� � w►'1 <br />1�.��- `��u� � ���3 ��� � `I <br />CONTRACT PRICE OF WORK <br />'��7s��.�� <br />MECHANICAL <br />NO. I 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 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this ap lication and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be compl�with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provis�'of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the„ewner of this property to perform the work for which application is made and I comply with the <br />State tractors Law 18.27 RCW,.an'6�296.200 WAC. <br />��l .�' ,-'� l� i�y ��hl I(l�v D•'7 <br />� <br />ate <br />