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MIT 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 />/ <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �6 / /D <br />SITE ADDRESS PARCEL TAX I.D. # PE IT # <br />.3 ► �049-0/D <br />� h on 1 <br />LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br />OESC. �- v�v is, � O C 4 FT <br />OWNER ADDRESCITYIZIP PHONE <br />TENANT E <br />CONTACT FOR ERM/IT� PHONE <br />e-`(�" � �,1(C�.� EMAIL <br />BRA A66RE$'� <br />D� <br />CONTR. LICENSE # <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />���, �+� � \ 4Eledric _Gas _Other /a� <br />I I r <br />WORK DESCRIPTION <br />� r <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C —air handling units <br />Forced air systems <br />J�B�Ihlub <br />Lavatory (wash basin) <br />= <br />Gas piping <br />Water heater <br />Shower <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Clothes washer <br />Water healer <br />� <br />Gas range <br />Clothes dryer <br />Range hood <br />_ <br />Sink (servicelbar/mopletc.) r <br />� <br />Exhaust tan <br />Heat <br />_ <br />BackOow preventer <br />� <br />pump <br />Unit healer <br />Urinal <br />Drinking Fountain <br />Boiler <br />_ <br />_ <br />Floor drain <br />� <br />Refrigeration <br />Woodstove <br />_ <br />Grease trap <br />Roo drains <br />—Other <br />_ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 710ti <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be romplied 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 />corutrucl' . That I am authorized by the owner of this property to perform the work for which application is made end I comply with the <br />Slat Contr tors Law 18.27 RCW a 296.200 WAC. <br />r <br />Signalur olOwnerlContra torlAu o gaol ale I Iv <br />