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P�MIT APPLICATI� <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 /> � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTE <br /> SITE ADDRE$S PARCEL TAX I.D.# PERMIT# <br /> L 2 _(�C �L � � C�b 02_ Z-�'� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION • / <br /> ;}�(.'•�C�1�(./ ��LGQQi <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C–air handling unils <br /> _ 8athtub Forced air systems <br /> _ Lavatory (wash basin) Gas piping <br /> Shower W ater heater <br /> _ Kitchen sink 8 disposal Gas freplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Ctothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/badmop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> ' Drinking Fountain Boiler <br /> I _ Floor drain _ Refrigeration <br /> � _ Grease trap Woodstove <br /> Roof drains Other <br /> I =I Olher — <br /> ' CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this rype of work will be compliea�.vilh�vhether specified herein or not.The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am auth ized by the owner of this propeny to perform the work for which application is made and I comply with the <br /> Stale Contracrors a� 7 RC'N d 296200 WAC. <br /> i - <br /> � � lU��� <br /> Signature of enCon«actor/Authon a Age�C �ate <br />