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f <br /> , F�RMIT APPLICATIVN <br /> `o��e��,�a� CITY O�F E�VERETT PERMTIrTW ERV�ICES <br /> � 425-257-8810— FAX 425-'257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CAROS ARE NOT ACCEPTED <br /> E ADDRESS �(. V,yG�"' PARCEL TAX I.D.ik PERMIT 0 <br /> Z 2-,f/ ^l/h,��l� l I ��� �C �J.S��D` �'/7 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER , ADDRESS CITY2IP PHONE <br /> po.���, �i�ti��,�� ����A��� /C�,y i �sl� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ��u1v�Zi�'�/ <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.UCENSE p <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> [Iectric _Gas Olher <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR IYEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel AIC—air handling unils <br /> Bathtub Forced air syslems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Laundry lray Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> Flcor drain Retrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS�705 <br /> I hereby cerilify lhat I have read and examined this application and know the same lo be true and correcl. All provisions of laws and <br /> ordinaces governing this lype of work will be complied with whelher specified herein or not.The granling af a permit does not presume <br /> to give authorily to violate or,cancel lho provision of any olher state er local law regulalin�construction or the perfortnance of <br /> construction.7hat 1 am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> St e Conlr ciors La 18.27 RCW and 296.200 <br /> /' ;� � � <br /> � �— .-,.. z% /o� j <br /> gnat r wnedConh cror/Authorized Agent Date <br />