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, <br /> �CRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE?T,�'+A 98201 <br /> 425-257-8810—FAX 425-257-Sis57—www.everettwa.orQ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /2�5..0(p <br /> SITE ADDRESS ) PARCEL TAX I.D.R PERMIT t <br /> ��-�-� � �tt7 G` CO�O /e1- _ <br /> LEGA LOT NO. BLOCK TRACT <br /> DES0. � <br /> NER�£ <br /> ' vha;�Serl ���- �- (��� �. �i� 339-aa� <br /> 7EN T NAME CONTACT FOR PERMR ��E <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE N <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Elechic Gas Other <br /> WORK DESCRIPTION 'I <br /> PIUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _, AIC—alr handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) = Gas piping <br /> Shower _ Water heater <br /> � Kitchen sink 8 disposal Gas flreplace <br /> Dishwasher „� Gasrange <br /> + Clothes washer _ Cbthes dryer <br /> Water heater _ Range hood <br /> Sink(service/bar/mop/etr..) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unil heater <br /> Orinking Fountain _ Boiler <br /> Floor drain ReBigeralion <br /> Grease trea _ Woodstove <br /> Roof drains _ .7ther <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAIf CODE IS N06 <br /> I hereby ceritiry that 1 have read and examined lhis application and know the same to be true and cortect. All provisions of laws and <br /> ordinaces governing this lype ot work will be complied with whether spec�ed hereln or nat.The granting of a permit doea not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulatlng construcdon or the peitormance of <br /> construction.That i am authorized by the owner of this property to perform lhe work for which applicatlon is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> Signature of OwnedContraclorlAuthorized Ac�ent ate <br />