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P�r2MIT APPLICATIG�� <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 /> /0-�3 ��j <br /> APPLICATIONS ARt ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> S���R S 1F: � /.^� _ O PARCrE�LTAXI.�# 0 p �jlc.l [D—Q�/Z— <br /> � <br /> LEGAL LOTNO BLOCK TRACT <br /> DESC. <br /> ��c,�r � h'I � G�e,l �-t�'S C��11e�e� �1��c���e.�-��P Gt�� . � ��- <br /> T��NT�NA I CON�TACTFORPE IT� ���N�/�_ IC� � � <br /> �c�'JC� ��1�( ' i , � .. <br /> V� <br /> CONTRACTO � - - _ AD�RE55 CITY2IP PHONE <br /> ' -� ��= 2S Q l��.E'--(� ��''�r- > <br /> NT 2.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> C',j��-r�'L� _Electnc _Gas_Other N <br /> `��qtv'Vl�l�U 1L�� d� UC�����I 6 7�� ����� G4�-+-� � L'O� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handlinc� units <br /> Bathtub Forced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> � _ Dishwasher _ Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflo��v preventer Heat pump <br /> I _ Urinal _ Unit heater <br /> Drinking Fountain Boiler <br /> � Floor drain Refrigeration <br /> � Grease trap Woodstove <br /> _ Roof drains _ Other <br /> i _ ORier _ <br /> CITY OF EVERETT LOCAL SAlES TAX CODE IS 3105 <br /> i I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of Iaws and <br /> ordinaces governing this type of work will be complied wilh�vhether specified herein or not.The granting of a permit does not presume <br /> to give authonty lo violate or cancel the provision of any other state or local law regulaUng consWction or the performance of <br /> construction.That I am authorized by ihe owner of this property to perform the work for which applicalion is made and I comply with the i <br /> Sta e-e6nTr� ors Law 1 . RCW d 296.200 W <br /> ���� ,� � 3 �y <br /> �gnature of �vnen tr torlAuthonzed Agent / Date <br />