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PE���MIT APPLICATI��� <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 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT tl <br /> S 3lo C2aw,c� �j,�i�� - M o o -c <br /> IEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PNONE <br /> /-7��4r� �� (.t(LI1��-- ���o �UcJ� /J2JC �J[nr� y2� 3o3-lBSI <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# /✓l`� �J <br /> C/ <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> S -�'�/'�� _Electric _Gas Y Other <br /> WORK DESCRIPTION O� � <br /> � �� r� �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF PIXTURE OR ITEM <br /> _ Toilet A/C—airhandlingunits <br /> _ Bathtub � Forced afr systems <br /> _ Lavatory(wash basin) � Gas piping <br /> _ Shower ✓ Waterheater <br /> _ Kitchen sink&disposal v Gas fireplace <br /> _ Dishwasher � Gas range <br /> _ Ciothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mopletc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Fioordrain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Othar — <br /> CITY OF EVERETT LOCAL SAIES SAX CODE IS 7105 <br /> I hereby ceritify that I have read and examined lhis applicaUon and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this rype of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authoriry to violate or cancel the provision of any olher state or local law reguladng constructlon or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. <br /> �//�/�/.c Y-Zsr-a�1 <br /> Signature of Owner/Contracror/Authonzed Agent Date <br />