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PL�tMIT APPLICATIO�d <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org �b `o�6—Oy <br /> / <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SI?�P�DRESS PARCEL TAX I.D.# PERMIT A� <br /> j`6 0 � Eh G��d �v� - <br /> LEGA LOTN . BLC^': TRACT <br /> DESC. <br /> OWNER � ADORESS CITY2IP PHONE <br /> �t ln a Gt� P <br /> TENANT NAM_ I CONTACT FUR PERMIT PHONE <br /> CONTRACTOR}}�-� ADDRESS CITV2IP PHONE <br /> w�l� N�f d-�ire inc 173a1 i 7 e St S E #� Mo,�ro � 3Co7 S4'P61 i <br /> CONTR.LICENSE A W� / �� �/ � ���� Z '���� <br /> 1 / � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 1 0 `.y�e _Eiectric _Gas_Other '7 0 � Q <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM , N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink& disposal Gas flreplace <br /> Dishwasher Gas range <br /> Clothes washer Ciothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etcJ Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove � <br /> i Roof drains Other <br /> I = Other_ _ �. � � �r <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and axamined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give aulhority to violate or cancel the provision of any other stale or local law regulating construcUon or the performance of <br /> construc 'on. That I am authori by the owner of this property to per(orm the work for which application is made and I comply with the <br /> Stale onlr awiJ and 296.200 WAC. <br /> ✓ �� <br /> �) ��0� �oaN <br /> i Signat e o( wnedContractor/Authonzed Agent Date �/ <br /> Z I <br />