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SITE ADDRESS <br />N, <br />IEGA LOT NO. <br />NAME <br />coNrRncroR ,� ��� <br />PE�tMIT APPLICATIO�V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />sh <br />C'on s <br />CONTR.LICENSENL�RS!—C �J <br />USE OF BUILDING <br />a,% <br />PARCEL TAX I.D. A� <br />Oo S1�32 -353— <br />TRACT <br />—DO <br />l ��i �+���I /G n� �vC �'i� 1�8d01 <br />CONTACT FOR PERMIT PHONE <br />111 i�e �.arsr.n y�.s - 3 a� - <br />ADDRESS CITY2IP PHONE <br />ao� c� �;,n� a, �p3 ��«�N �aog <br />10N <br />HEAT SOURCE <br />Electric � Gas _ Other <br />WORK DESCRIPTION /i• 1 h ��odN / a(�rF�ny <br />��� T� en <br />� <br />��l - � �c�. e'� � � <br />LUMB G �^ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishw�sher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />C� rp� �Y`(�k �r <br />NO. <br />IT / <br />> ofc�1 � <br />aS�-!a o/ <br />d 53 s <br />47.5- j7,} <br />CONTRACT PRICE OF WORK <br />� II� SDO, 00 <br />(� , li <br />'10v���1 Ay� 0�1 <br />= t� •�Cv� ��(,�Jl <br />MECHANICAL <br />TYPE OF FU(TURE OR 17EM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clathes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Reirigeretion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9705 <br />I hereby ceritify that 1 have read and examined this applicaUon and know the same to be true and correct. All provislons of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The granting of a pertnit does not presume <br />to give authoriry to violate or cancel the provisfon of any other state or local law regulating construcUon or the performance of <br />construclion. That I am authorized by the owner of this property to pertorm the work for which application is made and I comply with the <br />Slate Contractors Law 18.27 RCW and 296. 0 WAC. <br />`�If�//� � � � I - o �O <br />SignaWre of OwnedContractor%�orized Agent Date �i <br />