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P�RI1►11T APPLICATI�1 <br /> CITY OF EVERET7 PERMI7 SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 -www.everettwa.org <br /> �-F�'�''J <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SIT�ADDRESS /��p� ���vy�� PARCELTAXI.D.# P'nA � O��[ � <br /> ' Vt y <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TeNANjNAME CONTACTFORPCRMIT PHONE � <br /> 1/ <br /> � �II��"�-��A1 G� <br /> CONTRACTOR ,Q��✓fey rQ.e�"Q�Gt/�¢i..+' A�DRESS �'�p j 5�•iF �._� CIN21P PHONE �{Y$� 7�fj.7`f.�'1 <br /> n.c�� 1'� 4tra�� <br /> COWTR.LICENSE# y �� e� <br /> � c} �J- ��. �f �� � ---' � -!j � <br /> USE OF BUILDI� H[AT SOURCE I CONTRACT PRICE OF WORK <br /> r �,�' ' _Electric Gau_Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICP�L <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air I�andling units <br /> Bafhtub Forceti air syslems <br /> Lavalory(wash basin) _ Ga;piping � <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireolace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Laundry lray _ Range hood <br /> Sink(service/badmop/etc.) _ Ezhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinkinc� Fountain Boiler <br /> Floordrain � Retrigeralion <br /> _ Grease trap _ Woodstove <br /> Roof drains 07her <br /> Other _ <br /> � CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> I <br /> I hereby ceritify that I have rcad and examined this application and know lhe same to be true and correcl All prov':sions of laws and <br /> ordinaces goveming this type of work will be complied wilh whelher specified herein or noL The granling of a permil does not presume <br /> to give aulhoriry to vio!ate or cancel the provision of any other state or local law regulating consWclion or lhe performance of <br /> wnstruction.That I am authorized by the owner of lhis property lo pedorm the work for which application is made and i comply with lhe <br /> i Stale Conlrectors L� .27 R nd 29&.200 WAC. <br /> ,� <br /> 7 t") OS~ <br /> SignaWre of Owne qntrac or uthonzed gent D te �/� <br /> / r <br /> \ <br />