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P�RMIT APPLICATId��I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBfT R CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.A PERMIT t / <br /> � ��� u�/ 1/ �� — <br /> LEGA LOTNO. BLOCK TRACt <br /> DESC. <br /> pWN ADD S CITY E <br /> U ' //� ' <br /> TEN NAME CONTACT FOR PERMR PFIONE <br /> O� <br /> CpNntACTpF� ADDRE9S CITV2IP PHONE <br /> CONTR.LICENSE A /, n P^ � <br /> f�c <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ElecMc Gas_Other <br /> WORK DESCRIPTION � � <br /> �'x � �� �/-S� �i S� -� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FOCiURE OR IiEM NO. TYPE OF FIl(7URE OR ITEM <br /> Toilet A1C—air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) Gas pipfng <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Laundry tray _ Range hood <br /> � Slnk(service/bar/mop/etc.) _ Exhaust Nan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeradon <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS J10S <br /> I hereby ceritity that I have read and examined this application and know the same to be Uue and cortect. All provisbns of laws and <br /> ordinaces goveming this type of work will be complied with whether specfied herein or rwt The grandng of a permit does not presume <br /> to give authority to violate or cancel the provision af any other state or local law regula8ng constructlon or the performence of <br /> construction.That I am authorized by the owner of this property to perfortn the work for which applkatlon is made and I compty with the <br /> State Contractors La 1�27 CW and 296.200 WAC. � <br /> �/ ✓ _ , <br /> Signature o O� er ontra thonzed gent ate <br />