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PL�tMIT APPLICATIC�� <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 -DEBIT 3 CREDfT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.• PERMR� <br /> � <br /> \ <br /> LEGA OTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS P PHONE <br /> TENAdff1F,�ME CONTACT FOR PERMIT PHONE <br /> —F-� �- <br /> / S c31 1 <br /> CONTRACT R A���L��� }{�y�� ADDRESS CITY2IP PHONE <br /> z664�rs/63 <br /> CONTR.UCENSE N <br /> AF�.n2N��isi '�5 9 � 1�' � �c � 5�� ww 9g►�.� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �� 'Qt �UQ1qUA� —Electric _Gas_Other ����� <br /> WORK DESCRIPTION ?y -� ��� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Tollet A/C-alr handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> D(shwasher Gas range <br /> Clothes washer Cbthes dryer <br /> Laundry tray Range hood <br /> Sink(service/barlmop/etc.) �, Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX COOE IS 3105 <br /> 1 hereby ceritify that I have read and examined this applicatlon and know the same to be true and correct. PJI provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specfied herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulatlng constructlon or the performanca of <br /> construction.That I am authorized by the owner of lhis property to peAorm the work for which applfcation is made and I comply with the <br /> 5lale Conlractors Law 18.27 RCW and 296.200 WAC. <br /> /> = isn � c3/�?I/�Jti <br /> �ign�urQof O ner�njracror/Authonzed Agent DaTe— t/� <br /> -- �—._�� ( <br />