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<br /> PEkMIT APPLI(�A�IOfv
<br /> CITY OF EVE:RETT PERPJIIT SERVICES
<br /> ' � 3200 CEDAR STREET, EVERETT, WA 98201
<br /> ���� 425-257-8810—FAX 425-257-8857—v�nvw.everettwa.org
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<br /> A"PLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � ( � �3 `� � �
<br /> I SITE AD�RESS PARCEL TAX I.D.# PERMIT# �,
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<br /> rl�/�^'. LEGAL I.OTNO. BLOCK TRACT ��-'�.,
<br />'f DESC.
<br /> ' OWNER ADDRESS CITY/ZIP . PHONE
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<br />��tii.����. TENANT NAME [ CONTA�jT FOR PERMIT PHONE �tf}
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<br /> ` CONTRACTOR � � AD�RESS CITl21P PHONE
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<br /> '�' CONTR.LICENSE iF
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<br /> ����, USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK -�
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<br /> `} �JiL�if�� ) '� ilL _Eleclric h Gas_Olher � � �� �.� '�� � . '�'-
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<br /> � WORK DESCRIPTION �
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<br /> -�r: ;, PLUMBING MECHANICAL i�„
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<br /> ''��';' N0. TYPE OF FIXTl1RE OR ITEM NO. TYPE OF FIXTUR�OR ITE�d
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<br /> .�'�'��i Toilel A/C—airhandlingunils
<br />� � Balhlub Forced air syslems
<br /> � Lavatory(wash basin) _ Gas piping
<br /> t 2. _ Shower _ Waterheater
<br /> x`;,'�, Kitchen sink 8 disposal Gas freplace
<br /> � �• ' Dishwasher Gasrange
<br /> ..•.,u �, _ Clolhes washer _ Clothes dryer
<br /> � Waler heater Range hood
<br /> F Sink(service/badmop/etc.) _ Exhaust fan
<br /> , Backflow preventer _ Heat pump
<br /> Urinal Wiit healer
<br /> Drinking Fountain Boiler
<br /> Floor�:ain Refrigeration
<br /> Grease Irap Woodstove
<br /> Roof drains Olher
<br /> Other
<br /> CIN OF EVERETT LOCAL SALES TAX COUE IS 3105
<br /> I hereby ceritify lhat I have read and examined lhis application and know lhe same to be true and correct. All provisions of laws and
<br /> ordinaces goveming this type of work will be complied with whelher specified herein or noL The granting o(a permit does not presume U;
<br /> � to give authority to violale or cancel the provisiun of any olher state or local law regulating construction or the performance of �I
<br /> conslruction.Thal I am authorized by the owner of lhis property to pedorm lhz vrork for which application is made and I comply wilh the �- ���
<br /> ,. ,,, StatG ontractorg,Law 18 27 RCW and 29G200 W C. ;4
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<br /> ��.' ; Signalure of Own r/Contractor/Authorized Agenl / Date
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