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SITE <br />PERMIT APPLICA'ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />�D —3-0.� <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org ���� � _ � <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br />LOT N0. <br />TENANTNAME <br />9LOCK I TRACT <br />PARCEL TAX I.D. A <br />PHONE <br />3 <br />��CAC �ru� ��Znc� ( 2�U(�' y l�- la�l�['1 <br />CONTRALTOR ADORESS CITY/ZIP PHONE <br />IR�}i SanNOrhes =�c. i o�a� �,u9�Le� Wy *�as•y�3 �ve,�ett 4�a0'( �{�5•43i5-1a 31�9 <br />CONTR. LICENSE / <br />USE OF BUILDING <br />WORK DESCRIPTION <br />� �,�v C.��: <br />PLUMBING <br />N0. I TYPE OP FIXTURE OR ITEM <br />Toilet <br />8athtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbadmop/etc.) <br />Backflow preventer <br />Urinal <br />Dnnking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Eleciric ✓Gas _ Other <br />����c.. /U'� <br />� ;�'� �zo a <br />NO. I <br />CONTRACT PRICE OF WC�RK <br />�rvje..c..-�- 'nar�e- S <br />�(`RGcl�l� I..:�,ne� <br />TYPE OF FI%TURE OR ITEM <br />rvc — air hanming units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Rehigeration <br />Woodsiove <br />Other <br />CITY OF EYERETT LOCAL SALES SAX CODE IS J705 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct All provisions of laws and <br />ordinaces governing this type of work will be complied wdh whether specifed herein or not. The granting of a pertnit does not presume <br />to give authonty to violate or cancel the provision of an� other s;ate or local law regulating consvuction or the pertormance ot <br />construction. That I am authorized by the owner of this propeny to perfortn the work for which application is maoe and I wmply with the <br />State Contract , Law 1827 RCW and 296200 WAC. <br />��.d.�n i7�' �V�Cu�C�-�„ ��t�( fJ� � <br />Signature of Owner/Contrador/Author¢etl Agent Date � ' /2 <br />