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PEi .MIT APPLICATIOh <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA �8201 <br /> 425-257-8810- FAX 425-257-8857- www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.0 PERMIT N <br /> � �'( C ,,� r � J�--� <br /> LEGA LOTNU. � BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY/ZIP PHONE <br /> 1`� e�� r�,�� 1-i YY l Y l 1 ' f� I . �, -4c ,,, � �� � C �i c�u �- �'f V � �-Q-� �,l�c-� �1 x Z� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRA:.TOR ADORESS CITV2IP PHONE <br /> CONTR.LICENSE 71 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> _[loclric _Gas�Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handling uni�s <br /> BatMub � Forcod air sys�oms <br /> Lavatory(wash basin) Gas piping <br /> _ Showor � Water healar <br /> Kitchen sink 8 dis��sal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Laundry hay Range hood <br /> Sir.k(service�badnop/o�c.) Exhaus��an <br /> BackOow prevonti�r Hoat pump <br /> Urinal Unil healor <br /> Drinking Founlain Doiler <br /> Floor drain Relr!geration <br /> _ Grease trap Woodstove �, <br /> Rool drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TIU(CODE IS�105 <br /> I heroby ceritily ihal I have roaA and examined�his applicalion and know the same to be irue and correcL A�I provislons of laws and <br /> urdinaces yovorning Ihis lype of work will be complied with whether specilied herein or noL The granlinp of a permit does not presume <br /> to givo aulhority to violato or cancel iho provision ol any other stato or local law regulaling wnstruction or the peAoimance of <br /> conslruction.That I am aulhorized by Iho ov.�ner of this property lo perform the work lor which application is made and�compiy wilh Ihe <br /> Slate Contrectors Law 1D.27 RCW and 296.200 WAC. <br /> l � V�Y�\��_ \. Y1 �\� "l�.l��G-� <br /> Sic�natum ef OwnedContractod�uthonzad Agent Date i <br />