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P RMIT APPLICATI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everetNva.org <br /> APPLICATIONS ARE ACCEPTEO FROM!AM TO 4 PM 3_/ '�_O � <br /> SITE ADDRE38 PARCEI TAl(I.D./ PERMIT t <br /> � ��� ��. , � x 3-a <br /> LEGA LOT NO. � BLOCK TRACT OR 3UBDMSION N <br /> DESC. <br /> OWNER ADD ESE CITY21 PHONE <br /> / �� J / i- �C. �c'/p <br /> l �L ll� '/ `� �/ L /.% `� �r��/� / �/.�-'�Gt��'G %/�/i'..s'a;rc� J�d �i <br /> 7ENANT� CONTACT FOR PERMIT PMONE / <br /> / /! I � <br /> �)�etmc�i (` � I�`, L� G C�_,.?� , �! --_ '� e.r�u� <br /> CONTR.UCENSE M <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��` <br /> �Electric Gas Other <br /> �/;� � �- — — �,=,,`,`,,. <br /> WORKDESCRIPTION , , �; f�•; , ,. -i/��� /7 <br />!;: PLUMBING MECHANICAL <br /> ' NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> ,� ,i. Toilel _ AIC–air handling units <br /> Bathtub Forced air systems <br /> r/_ Lavatory(wash basin) _ Gas piping <br /> Shower Walar heater <br /> Kitchen sink 8 disposal _ Gas(ireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> � � Waler heater Range hood <br /> j _ Sink(service/bar/mop/elc.) � Exhaustfan <br /> BackBow proventer _ Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Reirigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Other_ <br /> Other <br /> CIT OF EVERETT LOCAL SALES TA7C CODE IS J105 <br /> I hereby ceritify that I have read and examined this application and know lhe same to be true and cortect. All provisions of laws and <br /> ordinaces goveming lhis type of work will be complied with whelher specified herein or not.The grantlng of a pertnil does nol presume <br /> to give authority to violale or cancei lhe provision of any olher state or local law regulating consUuction or lhe perfortnance of <br /> construction.Thal I am aulhorized by the owner ot lhis property lo peAorm the work for which applicatlon is made and I compiy with lhe <br /> Slale Contractors Law 18.27 RCW and 296.200 WAC. � <br /> � / . <br /> � �; " �.�.. �%� " � /i l <br /> Signature of OwnedContractor/Aulhonzed Apem . Date <br />