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P6MIT 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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />RMIT # <br />40 _ co3 <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER CITY/ZIP PHONE <br />' "` c"J jADDRESSSS /+ <br />k rid' �rc ShY{ a 1 �, t C Olt r-c,V , b &4 W. - %7 CD I <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />�Ct��c� vlc��✓s ells ay6 a701 (� 6f <br />CC`1TRACTOR Mr fTSter ADDRESS CITYIZIP PHONE <br />1120 SW. 161t` �Q.ti�,ti gpc 8cF- <br />CONTR. LICENSE" M tR 11.00t� -O'z i'_ tj C C7� S1 0•7 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I — Electric Gas j<' Other <br />I <br />WORKDESCRIPTION ���� rr \vCH�LerJ ��P -(r6yr-\ Yhje_4r` `�o �t n�a�lr✓\ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />A/C - air handling units <br />Bathtub <br />_ <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/barimop/etc.) <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal I <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />I — <br />i <br />Roof drains <br />Otherl4(1�C'r <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 knr (he same to be true and correct. All provisions of laws and <br />ordinaces Bove ing his type pf work will be complied with whether specified herein or not. The granting of a permit does not presume <br />�to �ncel <br />to on vi to or the provision of any other state or local law regulating construction or the performance of <br />construction. at I a auth rued by the owner of this property to perform the work for which application is made and I comply with the <br />late Contra ors Law 1 .2 CW and 296.200 WAC. <br />-�11y <br />Signa re of wn onlractorlAuthorized Agent D e <br />