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: � �� C_— <br />SITE /� D SS <br />-� —: _ <br />LEGAL LOT N0. <br />DES0. I <br />OWNER <br />� �ni <br />TENANTNAME <br />CONTRACTOR <br />P�RIVIIT 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 �ROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />�'fl�`.���..� ,��cJ`-iviUC. <br />OLOCK <br />1'�/.� l� n' V l. <br />_l .--� �. . (J C 1 <br />CONTACT FOR PERMIT <br />ADDRESS <br />CONTR. LICENSE # � � � � ;1 � S � � L �. <br />i� <br />USE OF BUILDING <br />S�Z <br />HEATSOURCE <br />Eleclric � Gas _ Olher <br />3 �� s-o5 <br />RMIT # <br />;��' J�_j" <br />_re>t- <br />CITY/ZIP PHONE 4tj 1.� ; -�� <br />�V S{Nc.�� <br />C ��i� l,.� ,� <br />PHONE <br />CITY/ZIP PHONE <br />� c/ , <br />���i `C.�JW <br />CONTRACT PRICE OF WORK <br />(�l">, uU� . <br />WORK DESCRIPTION ' <br />�,�� i ( l !� ��{ � �( S ��Z . %���1 <br />+J <br />PLUMBING MECHANICAL <br />Np, � TYPE Of- FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & c'isposal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (service!bar/mop/etc.) <br />Bac�ctlow pre�•enter <br />Urinal <br />Drinkin� Founlain <br />Floor drain <br />Grease trap <br />koof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />� <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas (ireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unil healer <br />Bailcr <br />Refrigeration <br />Woodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAi( CO�E IS 3t05 <br />I heraby ceritify that I have read and examined lhis applicat�on �nd know Ihe same to be lrue and correct. All provisions of laws and <br />ordinaces goveming this rype of work will be complied with whelher specified herein or noL The grenling of a permit does nol presume <br />lo give authority to violale or cancel lhe provision of any other slate or local law regulating conslruction or lhe pedormance of <br />conslruclion. That I authorized by the owner of lhis property lo per(orm lhe work for which application is made and I comply wilh lhe <br />State Contr2ctors La� 18.27 RCW and 296.200 WAC. <br />�,( `�` �!� /p,: <br />. ✓'I !> .\C,YfY� Z ( <br />