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( <br /> PERMIT APPLICATION <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 <br /> SITE ADDRESS p PARCEL TAX I.D.# PERMIT X <br /> ' U3�- .n<�_ 00 3� 7�-c� S-3 O� c_� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AUDRESS CITY2IP PHONE <br /> �/�� �-5-� -� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.UCENSE ii v�✓�.1�� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> ��' ��' s �— <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathlub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/badmop/elc.) Exhausl fan <br /> BackOow prevanter Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains Olher <br /> � Other <br /> CITY OF EVERETT LOCAL SALES T/V(CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this appiication and know Ihe same lo be true and correcl. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whother specified herein or nol.The granling of a pertnit does not presume <br /> to give authoriry to vioiate or cancel the provisiun of any other state or local iaw regulating construcllon or lho perfortnance of <br /> cons:ruclion.That I am authorized by lhe owner o(lhis properly lo pertorm lhe work for which applicalion is made and I wmply with lhe <br /> Slale C tors Law 18 7 R VJ and 296200 WAC. <br /> ///�!«.�A�//2� r-�-yr�+ .7�d��/ <br /> Si a ure t 0 er/ ntractor Authorized Agenl Date <br /> �� <br /> � <br />