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�cRMIT APPLICATI�,N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> �25-257-8810—FAX 425-257-8857—www,everettwa.org <br /> APPLI� 1TIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBI7&CREDtT CARDS ARE NOT ACCEPTED <br /> SIT�i DDRES" � PARrCEL TAX I.D.# P RMIT N — <br /> ��� 1 7 <br /> �� D Lb <br /> LEGA LOTNO. BLOCK TRqCT <br /> DESC. <br /> OWNER � ADDRESS CITY2IP PHONE <br /> M� I�(k��,M,r���c LI� 1Z(�w � ►3 �'�v � �vr,�tr-q8�3��° , <br /> TENANiNAME I CONTACTF PERMR PHONE <br /> CONTRACTOR ADDRESS CITY21p PHONE <br /> CONTR.UCENSE N <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> _Elechic G�s Olher <br /> WORK DESCRIPTION <br /> 1�, yw0• Ga✓'��Y-� <br /> PLUMBING MECHANICAL <br /> N�• TYPE OF FIXTURE OR ITEM NO. TYpE OF PIXTURE OR ITEM <br /> _ Toilet A/C—airhandlinyunits <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas pipfng <br /> _ Shower Waterheater <br /> Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/barimoFletc.) Exhaustfan <br /> _ Backtlow preventer Heat pump <br /> _ Urinal Unit heater <br /> __ Drinking Fountain Boiler <br /> _ Floordrain RefrigeraGon <br /> _, Grease trap — <br /> Roof drains _ Woodstove <br /> Other _ Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceri6fy thal I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will bo comptied with whether specified hereln or not.The granting of a pertnit does not presume <br /> to give authoriry to violate or cancei the pravision af any other state or local law reguiatlng construction or the pertormance of <br /> con truction.That I am aulhorized by the owner of lhis property to perform the work for which application is made and I comply with the <br /> ta ontractor Law 1 27 RCW and 296.200 WAC. <br /> C � IIID� <br /> S at e of OwnedContracto uthorized Agent Date <br />. <br />