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P�RMIT APPLICATIG���I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBR 6 CREDR CARDS ARE NOT ACCEPTEO <br /> SITE ADDRESS PARCEL TAX I.D.A I PE�` � � <br /> / 7 o r/�ll/I'7`T li� S�� � <br /> LE LOT N0. BLOCK TRACT <br /> DESC. <br /> NER ADDR <br /> / %0 7 /�ivz77 At� �G�"K�l7P w/�l �?10/ ��-0 6� 67�' 70�o <br /> �TEN T NAME / CONTACT FOR PERMIT PIIONE <br /> � ���'�A <br /> CONTRACTOR ADDRESS CRV/LW PHONE <br /> CONTR.IICENSE R � rt�^"� <br /> USE OF BUILDINIi HEAT SOURCE CONTRACT PRICE OF WORK <br /> _ElecMc _ Ges_Other rn , ,`_ <br /> WORK DE�CRIPTION <br /> J <br /> 3S� S� �- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR 17EM NO. TYPE OF FIXIURE OR REM <br /> Toilet AIC—afr handling uoits <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) � Gos piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Laundry tray Range hood <br /> 5ink(servicelbar/mop/etc.) Exhausl fan <br /> BackOow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeratbn <br /> Groase lrap Woodstove <br /> Roof drains Other <br /> _ Other <br /> CITY OF EVERETT LOCAL SALE9 7AX CODE IS 3105 <br /> I hereby ceritiry that I have read and examined this appllcadon and know the same to be We and correct. All provisbns of lews and <br /> ordinaces goveming lhis rype of work will be complied wilh whether specifled herein or not.The yrantlrp of a pertnk doea rat presuma <br /> lo give authority to violate or cancel the provisfon of any other state or local law regulatlng constructlon or the pertormance of <br /> construclion.That I am authorized by the owner of this property to perfortn the work for which applicatlon is made and 1 comply wRh the <br /> State Contrectors Law 18.27 RCVj�and 296.200 WAC. <br /> � <br /> � liz- ' t,/' ' � � �� <br /> Signature o ne antractorlAuthorize gent ate l /� <br /> � <br />