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P RMIT APPLICATION 6 _ , s�,9 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 ��G�OJ� <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -�So <br /> SITE AODRESS PARCEL TAl(I.D.N PERMIT/ <br /> � / !� tW;� <br /> LEGA LOT NO. BLOCK ?RACT OR SUBDIVISION M <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> •..k ��.,,t��• Po 3ox 147Sd �w.�a'T [� � �rP2c< <i2fnln -» >3 <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> EailA1L <br /> CONTR.UCENSE k C <br /> ���� <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �,4� _Electric _Gas_Other ��y �v U� <br /> . o <br /> WORK DESCRIPTION <br /> S�� ,��/h"• � , � <br /> (I - - <br /> PLUMBING aHAN CAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR REM <br /> Toilet A/C—air handling unfta ' . <br /> alhtub � Forced air systems <br /> � Lavalory(wash basin) Gas piping <br /> _ Shower � Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clathes washer � Clolhes dryer <br /> � Water heater � _ Range hood <br /> _ Sink(servicelbadmopletc.) �00� �� z Exhaust(an <br /> _ Backtlow prevenler � _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Retrigeration <br /> Grease lrap Woodslove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAI(CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined this application and krrow the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type o(work will be complied wilh whelher specified herein or not.The 9ranting of a pertnit does not presume <br /> to give aulhority to violate or cancel the provision o(any other state or local law regulating consWcUon or lhe perfortnance o( <br /> construction.That m authorized by the owner oi this properly to peRortn the work for which application is made and I comply with the <br /> State ContracSMs 98.27 W d 296.200 WAC. <br /> � .� <br /> _� D <br /> Signal e of O n n rac or Aulhorized Agent Dale I( <br /> 2 <br />