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P�r�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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 3 CREOIT CAROS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX D N PE IT� <br /> Oo�(�II(�b� oa(ad � L�-.3tS <br /> LEGA L07N0. BLOCK TRqCT <br /> DESC. <br /> OWNER ADORESS CI 21P PHONE <br /> TENANT AME CONTACT FOR PERMR � <br /> . I PNON <br /> CONTRpCTOR ADDRESS g • � <br /> CtTYQIP PHON <br /> CONTR.LICENSE A . . � -. <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _,ElecUic _Gas_Other �/j <br /> WORK�ESCRIPTION �� <br /> RE/�C/�t:E ?X� `' F-XTLl2/A2 F�'!IE F,7VT s77f/�¢.. <br /> PLUMBING MECHANICAL <br /> N�• TYPE OF FUCTURE OR ITEM NO. TYPE OF Ftl(TI)RE OR ITEM <br /> Bathtub _ NC—eir handl(ng units <br /> _ Lavatory(wash basin) _ Forced air systems <br /> Shower _ Gas piping <br /> _ Kitchen sink 8 disposal _ vJater heater <br /> Dishwasher _ Gas fireplace <br /> Clothes washer _ Gas range <br /> I _ Laundry tray _ Clothes dryer <br /> I _ Sink(service/barlmop/etc.) _ Range hood <br /> Backflow preventer Enhaustfan <br /> � Urinal Heat pump <br /> � Drinking Fauntain _ Unit heater <br /> � _ Floord2in _ Boiler <br /> Grease trap _ Refngeration <br /> Roof drains _ Woodstove <br /> _ Other _ Other <br /> ; CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicatlon and know the same to betrue and cortect. All provisions of laws and <br /> ortlinaces goveming this rype of work will be complied wilh whether s ecified herein or not The ranUn of a <br /> to give authonty to violate or cancel the provisicn of any other state o piocal law regulaGng consWction or the perfortnance of P�ume <br /> construction.That I am authorized by the owner of this property to pertorm the work for which applicadon is made and I comply with the <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. <br /> Signature o neuConlractonAu <br /> i � thonzed Agent . afe �/� <br />