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RMIT �4,PPLICA�T�N <br />�i�'l�' ��' EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE �iCCEPTEQ FROM 8 AM TO 4 PM - DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />�' -��S ��� � ���c__. �� �! 5c�o ��� l ��� M � ��, :-. -- <br />LEGAL LOT NO. BLUCK TRACT <br />DESC. <br />NER <br />L LLj% � <br />TENANT NAME <br />�r� � ,�{-v�,s� � <br />CONTACT FOR PERMIT <br />l�f�`��� ���.�� �i <br />PHON <br />- �f �-`> -�5�-t��{�l <br />PHONE <br />�f 2� � ��-C"��G, �i <br />CONTRACTOR ADDRESS ,� CITY2IP PHONE <br />1�,�, ��--,� f� pz u;��„� �_ � t�T�- �G�� ��/ �3� .� . r�. ��, �,� � �.� -� �s-� ��� �� <br />CONTR. LICENSE # _^ <br />�A'�'n%.��lf duL.�C j� �1 �:� / <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Electric �•Gas _ Other � �� l Gf �+C�� <br />WORK DESCRIPTION <br />�'V 5"i .92-L /V c Gv' �T-� S �L� e''�/. �f-C=� � � �-ivl � f�� iZ 5,�,2�; <br />P�Ult��l <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <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 />MECHANICAL <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />_L Forced air systems <br />Gas piping <br />Water heater <br />Gas firepiace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <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 application and know the same to be true and correct. All provisi�ns of laws and <br />ordinaces governing this rype of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />+^ give authority to violate or cancel the p�ovision of any other state or local law regulating construction or the performance of <br />struction. That I am authorized by th2 owner of this property to perform the work for which application is made and I comply with the <br />..�ate Contr�tors Law 18.2J�R�'✓� and 296.200 WAC. <br />��- f �S <br />Date <br />