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r. _____...... <br />I <br />SITE ADDRESS <br />�),•. _� �; .: <br />LEGAL� LOT NO. <br />DESC. � <br />,�,1 , <br />�,n. !` !� <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSF N <br />USE OF BUILDING <br />PtRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetiwa.org <br />APPL�CATIONS ARE ACCEPTED FROM 8 AM TO 3 PM <br />PARCEL TAl( I.D. p <br />� ��� <br />, -- <br />�BLOCN TRACT <br />ADDHESS <br />i)�� . %�; .. _ <br />CONTACT FOR PERMIi <br />ADDRESS <br />I — HEATSOURCE <br />Eleclric ,as Other <br />WORK OESCRIPTION <br />/� . . `, <br />�� /,.'i - � i-��t ��-!�; —,�� �L�9 <br />N0. TYPE OF FI%TURE'JR ITEM <br />TOtlL'1 <br />DathWb <br />Lavalury (wash basin) <br />ShaNr� <br />Kilchan sink 8 dispos�! <br />Uishwasher <br />Clo�hos washor <br />— - Waloi hcalor <br />� Sink (servicelbadmop�utcJ <br />Backllow prevcnlr.r <br />Urinat <br />� Drinking Fr,dn��ir. <br />Floor drain <br />Greasolrap <br />Roof drains <br />Other _— _ --- --- <br />���RMIT p <br />L� %L'� - ��/C--. <br />PHONE <br />CITY�Z�P PHONE <br />CONTRACT PkICE OF WORK <br />�-- <br />((_ �lC. �� �- <br />-- MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC - air handling unils <br />Porced air sysloms <br />Gas pipinc� <br />W ater heater <br />Gas lireplace <br />Gas range <br />Clothes dryer <br />Rango hood <br />Exhaus� lan <br />Heal pump <br />Unil hoater <br />Boilor <br />Refri�era�ion <br />Woadslcve <br />Other __ <br />CITY OF EVERETT LOCAL SAIES TAX CODE IS 7105 <br />I hr,reby cerilify lhal I havo road and examined Ihis applicalinn and Anow Ihe same to be true and correct. All provisions of laws and <br />ordinacos yovoming Ihis type of work will 6e comp�ied with whelher specified herein or not. The graMing ol a permit does not presume <br />to yive authority lo wolal� or cana�l Ihc provision ol any other stale or local law regulating cons!ruction or ihe performancv of <br />consiruclion. That I am :,ulhorized by ihA owner o1 �his properly lo peAorm lhe work for which appliwlion is made end I r.on�ply with Ihe <br />Stat� CoN��nrs Law 1#i27 RCW �ind 2'J6.200 WAC. <br />�� .' � ,' , C �_- l- E-D� <br />