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PL.tMIT APPLICATIG.J <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 -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SIl'E ADDRESS tV PARCEL TAX I.D.# PERMIT N <br /> 4� 3 I Ca�r i �Q � I �aso 3�c3 <br /> LEGA LOTNO. BLOCK TRAC1 <br /> DESC. <br /> OWNER ADDRf:SS CITYIZIP PHONE <br /> �/1'1 iC���K K -e- � ��'t�� � zS� �f/ �' l � 3 � <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> 4��u so l a J i rn �H- .�2.�5 �{--I g I� 32 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> A-(��{1'� �j/"�l ( �I �Q� �.ElecMc _Gas_Other <br /> WORK DESCRIPTION <br /> �c_.�,u.�� r-���� ��.� 1�-��- . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF F�XTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Baihtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry Vay Range hood <br /> Sink(servicelbaNmop/etc.) E�chaust fan <br /> Backtlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> � Floordrain Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceriGfy that I have read and examined th(s appllca6on and know the same t�be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with wiiether specified herein or not.The granling of a permit does not presume <br /> to give authoriry to violate or cancel the provision of any other state or local law regulating construcGon or the performance of <br /> construction.That I am authorized by the owner of lhis property to peAorm the work for which application is made and I comply with the <br /> Slate Conlractors Law�8.27 RCW and 296.200 WAC. <br /> Signature of Owner/Contracror/Authonzad Agent Date <br />