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MIT APPLICATIG,J <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 />SITEADDRESS <br />PARCEL TAX I.D. # <br />p RMIpTA�#n <br />/� II <br />\ <br />LEGAL LOT NO. <br />Dena <br />BLOCK <br />TRACT OR SUBDIVISION # 3,613113213S <br />� 6/ 3 1 32 <br />Lo � <br />OWNER ADDRESS CITYIZIP PHONE <br />(AV � (�2 /CoPN(e CCx,r-)e, H � L�' (-iu&,�v- C' U, lFz ti 7'5zo3 <br />TENANT NAM <br />CONTACT FOR PERMIT PHONE <br />n � ram,, <br />' NV� <br />E-MAIL <br />CONTRACT R ADDRESS CITYIZIP PHONE <br />C Q^ /. / <br />CONTR. LICENSE tt I�� � ' l!-' M 00�-�-�' (ti( <br />I �" <br />USE OF BUILDING <br />HEAT SOURCE � <br />I 6`L <br />CONTRACT PRICE OF WORK <br />��� w\- ti4PDt�ia� <br />_Electric _Gas _Other <br />_ <br />WORK DESCRIPTION <br />i <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />N0. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C —air handling units <br />Bathtub <br />_Forced <br />air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />_Gas <br />fireplace <br />_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />_Clothes <br />dryer <br />_ <br />Water heater <br />_Range <br />hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />_Unit <br />heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />_Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 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 C ractors Law 18.27 RCW and 296.200 WAC. <br />-, _3 <br />$ign r�dl o Owner/Contr ctor/Authonzed Agent Date <br />'Iz <br />