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PERIVIIT 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 FROM 8 AM TO 4 PM �j ... ��—07 <br /> SITE ADDRESS PARCEL TAX I.D.# PER��M�* �� <br /> <.v <br /> L LOT NO. BL K TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE �/���Z•/� <br /> O <br /> � <br /> . <br /> TE4ANT E CONTACT FOR PERMIT PHONE a 4�r 2�j_�09 <br /> I � E�IIAIL � � � <br /> s�e�s=�.,s r3�6 ��Nfl � �r- s�.�� �.a 9�r2s <br /> CONTR.LICENSE# <br /> S��-`��r.7D <br /> USE OFBUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �1 I.�"�� I _Electric _Gas_Other �S O(� <br /> WORK DESCRIPTION <br /> �,.�11- 0� 2 C��nr�( l�(�ea-s C� j2tcc b.�ay <br /> / <br /> G . � MECHANICAL <br /> UMBIN <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF PIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhlub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer _ CWthes dryer <br /> Water heater Range hood <br /> Sink(service/barlmop/etc.) _ Exhaustfan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined lhis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be co�±�lied wilh whelher specified herein or not.The granling of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any olher state or local law regulaGng construction or the performance of <br /> conslruclion.That I am aulhorized by the owner of lhis property to perform the work for which application is made and I comply with the <br /> State Contraclors Law 18.27 RCW and 296200 WAC. <br /> -� �2z-��- <br /> Signature o o lor/Aulhorized Agenl Date <br /> l/� <br />