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P��.RMIT APPLICATII,N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org 3 - p 7-6� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P3RMIT# <br /> 4oz S �i�y s,— !N' �3 - � / <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORE55 CITY2IP PHONE <br /> ���,r.v �Nox �ozs fRrD.¢Y s� 9��0 � �Fzs ��,3 ->«>> <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR AD�RESS CITY2IP PHONf: <br /> CONTR.LICENSE# � <br /> �J�'�� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �6�,�� _Electric _Gas_Other <br /> i <br /> WORK DESCRIPTION <br /> ,�1�-%j �ll� S � U� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> Bathtub Forced air systems <br /> _ Lavatory(wash basin) l��_ Gas piping <br /> _ Shower � Water heater <br /> Kitchen sink 8 disposal Gas fiJept�e � '� � <br /> Dishwasher Gasrange <br /> Clothes washer � Ciothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> BackOo�v preventer _� Heat pump <br /> _ Urinal �C Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis application and know the same lo be true and correct. AII provisions of laws and <br /> ordinaces governing this lype of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violale or cancel the provision of any other state or Iocal law regulating construction or the performance of <br /> construclion. That I am authorized by the o�vner of this property lo perform the worl;for which application is made and I comply with the <br /> State Contraclors Law 18.27 RCW and 296 200 WAC. <br /> SignaWre of Owner/Conlractor/Authorized Agent Date <br />