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PE MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—wuwv.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� "j �O6 <br /> SITE ADDRESS PARCEL TAX I.D.M ,PER:d1T�i <br /> � nb t'Gc��� (� Cv/J- �o� _ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANTNAME . I CONTACTFORPERMIT PHONE <br /> t� F-- ��C� /L� � <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CJNTR.LICENSE N f)���(� ��1� ���c `f^ �t I <br /> � �/ � — <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Olher � `f�f z7 <br /> r <br /> WORK DESCRIPTION <br /> �x�' -, � �!`�c �� � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> BalhWb Forced airsystems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&dispcsal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/badmop/elc.) _ Exhaustfan <br /> Backflow preventer _ Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS 3705 <br /> I hereby cerilify that I have read and examined ihis application and know the same to be true and cortect. All provisions of laws and <br /> ordinaces governinc�this type o(work will be complied wilh whelher specified herein or not.The granling of a pertnit does not presume <br /> to yive authorily to vio�ate or cancel lhe provision of any other state or local law regulating construcGon or lhe perfortnance of <br /> construction.Thal I am authorized by the owner of Ihis property to peAortn lhe work tor which application is made and I comply with the <br /> Stale C tracto p La �W and 296.200 WAC. <br /> ./ /' � <br /> ignature o(Owner Conlractor/Authorized Agent Date <br /> � <br />