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<br /> � P�r'.MiT APPLICATI���
<br /> ��'"`° CITY OF EVERETT PERMIT SERVICES
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<br /> """"' � 3200 CEDAR STREET, EVERETT, WA 98201
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<br /> � , 425-257-8810— FAX 425-257-8857—wv✓w.everettwa.or� � � a.
<br /> ' �- APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED
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<br /> -,��4"k SITE ADDRESS /P(A+�RCEL TAX I.D.# PF�(tMIT# ,
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<br /> ��+ '��"%� LEGAL LO7N0. BLOCK TRACT
<br /> I DESC.
<br /> � � �� i OWNER ADDRESS CITY2IP PHONE
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<br /> � TENANT NAME CONTACT FOR PER�dIT PHONE i
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<br /> � ,N��`� I CONTRACTOR t,>��/�+ ,: � •���� �� ADDRESS CITY2IP PHONE
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<br /> , �i"'���" ' I USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK
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<br />� _E!ectric ,�Gas_Olher j �F C �
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<br />� WORK DESCRIPTION
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<br /> �:�+�;, i PLUMBING MECHANICAL �
<br /> 't'.`_�? I NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM
<br /> � Toilet AIC-air handling units
<br /> }i Bathtub � Forced air systems
<br /> °�` t��'� � Lavatory(wash basin) Gas piping I
<br /> �„ '`� ; _ Shower _ Waterheale�
<br /> � _ Kitchen sink&disposal _ Gas fireplace
<br /> ,� Dishwasher Gasrange
<br /> �� �'� - ' Clothes washer Clothes dryer
<br /> � � Laundry tray _ Range hood
<br /> � y'� I _ Sink(service/bar/mop/elc.) _ Exhaust fan
<br /> :;;..r„� _ Backflow preventer _ Heat pump
<br /> � _ Urinal Unit heater
<br /> ,'�. _ Drinking Foun[ain _ Boiler
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<br /> Floor drain Refrigeralion
<br /> �� �i _ Grease trap _ Woodstove
<br /> � ,,,:A ; _ Roof drains Other
<br /> "�`a _ Other
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<br /> �ITY OF EVERETT LOCAL SALES TAX CODe IS 3105
<br /> I hereby ceritify that I have read and examined this applicalion and know the same to he true and correct. All provisions of laws and
<br /> ordinaces goveming lhis type of work will be complied with whether specified herein or not.The granting of a permit does not presume
<br /> , =„�� to c�ive aulhority to violaie or cancel lhe provision of any olher state or local law regulating consWc9on or the performance of
<br /> consiruction.That I arn authorzed by the owner of ihis property to pedorm the work for which application is mzde and I comply with the
<br /> ,r Stale Conlractors Law 18.27 RCW and 296.200 WAC.
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<br />�,,. �� - , Sign2ture of OwnedContraclodAuthorized Agent Da:e
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