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PEi ..rVIIT APPLICATIOh <br /> CITY OF EVERcTT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-Ss310— FAX 425-257-b857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FkOM A AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT AC�CEPTED <br /> SITE ADDRESS —� PARCEL TAX I.D.# /P�RMIT p <br /> ?OGrj W, C�SWo ✓L-�J l� I� ' �' � �� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> QDEI/JC� <br /> TE�bE IMN b IrCi�I�(�M PER�G'•`�CCLS KI 1�ZJ ) � /L� I/7J✓� <br /> \ <br /> CONTRACTOR ADDRESS CITY2IP PHONE ��� <br /> 11�i75� <br /> CONTR.LICENSElI <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��=�Z�.G� _Eler,tric _, .Gas__Othcr I9� bO Cl <br /> WORK DESCRIPTION <br /> nE� 22�a���E PA �riT� or�S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toil�t A/C—air handlinc�units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water hea�er <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryor <br /> Laundry Iray _ Range hood <br /> Sink(sorvice/barlmopletc.) _ Exhaust tan <br /> BackOow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 7103 <br /> I hereby cerilify Ihat I have read and exarriined ihis application and know the same to be Irue and wrrecL All provisions of laws and <br /> ordinaces goveming lhis type of work will be complied with whelher specified herein or nol. The granting ol a permit does nol presumo <br /> to pive authonty to violate or cancel Ihe provision of any olher state or local law iegulating construclion or the pertormance ol <br /> construclion. That I am authorized by the awoer ol this propeAy lo perform lhe work lor which applicalion is made and I wmply with the <br /> Slate ntiac�ors Law 18 27 R W� a/nd�96.200 WAC. <br /> ��+^^��� ����` ��/6 <br /> ignature o Owne ConlradcuAuthonzed Agenl ! Date <br />