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<br />�� , C17Y OF EVERE7T PERMIT �ERVICES
<br /> �,� 3200 CEDP.R STREET, EVERETT, WA 98201 C( ��p�bf
<br />�,,�� 425-257-8810- FAX 425-257-8857-www.everettwa.org
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<br /> Y*"�'-, APPLICATIONS ARE ACCEPI'ED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED I
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<br /> SITE ADDRESS PARCEL 1'AX I.D.# PERAnII'# �/'7
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<br /> LEGAL LOTNO. BLOCK TRACT
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<br /> TEMANT NAME , CONTACT FOR PERMIT �� PHONE
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<br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK �".
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<br /> r'�g���� NJORKDESCRIPTION �7 '7 • - n - I' �,:5.' .� ��i%�c �-V, �x
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<br /> PLUMBING MECHANICAL
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<br />' '� � NO. TYPE OF FIxTURE OR ITEM NO. NPE OF FIXTURE OR ITEM
<br /> Toilet A/C-air handling units
<br /> Bathlub Forced air systems
<br /> -�x;,. Lavalory(wash basin) Gas piping
<br /> �� Shower Waterhealer
<br /> Kitchen sink&disposal Gas fireplace
<br /> "� Dishwasher _ Gasrange
<br /> � ��� Clothes washer Clolhes dryer
<br />� Laundy tray Range hood
<br /> x -�`--�. _ Sink(service/badmop/etc.) _ Exhausl fan
<br /> .�..,, .�. Backilow prevenler _ Heat pump
<br /> ;s`,,��, _ Urinal _ Uritheater
<br /> . ;fi�, _ Drinking Founlain _ Boiler
<br /> I _ Floor drain _ Refrigeralion
<br /> Grease lrap Woodstove
<br /> RooF drains Olher
<br />!� Other
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<br /> ''� CITY OF EVERE7T LOCAL SALES 7AX CODE IS 3105
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<br /> I hereby ceritify that I have read and examined this application and know the same ro be lrue and correct. All provisions of laws and
<br /> I ordinaces governing this lype of work will be complied wilh whether specified herein o�not The aranting of a permit does not presume
<br /> :,.,�,,, lo give aulhority to violale or cancel the provision of any other stale or local law regulaling construction or the performance of
<br />� - construclion.That I am authorized by the owner of this property to pedorm the work(or vihich application is made and I comply with lhe
<br />� , State Contrectors Law 18�27 RCW and 296.200 WAC.
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<br /> Signature of Owner/ ontractor/Authorized Agent Date G
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