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I��RMIT APPLICATI �C,nl <br /> CITY OF EVEREIT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 96201 � ..�l{.A� <br /> 425-257-8810-FAX 425-257-8857-www.everetlwa.org <br /> APPUCATIGNS ARE ACCEPTED FROM 8 AM TO 4 PM ��� - �� <br /> SITE ADDRESS _ / PARCEL TAX I.D.� PERMR R <br /> �� K <br /> LEGA LOT N0. BLOCK TRACT OR SUBDMSION II <br /> DESC. <br /> OWNER ADDRE89 CITY21 PMONE <br /> �� J, P.�JS��t ��rme5 <br /> TENANTNAME � CONTACT PERMIT PHONE �:� <br /> �%T�' ��O'�C �"—.�1 '" � � � E�MINL <br /> t�q.K�K r^^sE�rrc�o0 ��g3r na��ore� /j���(��r F� <br /> ON UCEN ����,�j� <br /> �� <br /> USE OF BUILDING HEAT SOURCE I �CONTRACT PRICE OF WORK <br /> ��L�[.(r _Electric _Gas_Other ����0�� <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> � Toilel A/C—air handling unils <br /> Bathtub Forced air systems <br /> ,� Lavalory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplece <br /> Dlshwasher Gasranpe <br /> Clolhes washer Clothes dryer <br /> � Water heater Range hood <br /> Sink(service/bar/mopletc.) _ E�ausl fan <br /> BackOow prevenler Heal pump <br /> ,�, Urinal _ UnH heater <br /> Drinking Fountain Boiler <br /> Floor drain Reftigeration <br /> Grease trap Woodstove <br /> Roo(drai s Other <br /> �_ Ofher _ <br /> —�-- � — <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS 7105 <br /> I hereby ceritify lhat I have read and examined this applicalion and know lhe same to be true and correct. Alt provisbns o(laws and <br /> ordinaces governing this lype of work will be complied wilh whether specified herein or not.The granling of a pertnit does not presume <br /> lo give aulhority to violale or cancoi the provision oi any other stale or local law regulating construction ar ihe pertormance of <br /> construction.Tliat I am authorized by lhe owner of lhis property lo perform the work for which application is made and I comply wilh the <br /> State CoNr ctors Lativ 16. CW and 296.200 WAC. <br /> oi �/Qi1't�G�BK 5�''2�/'L�8 <br /> Stgn u wner on ractor/Authonzed Agent Date <br />