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P�RMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADORESS PARCEL TAX I.D.N PERMIT N <br /> f MoA� � V� � <br /> LEGA LOTNO. BLOCK TRACT '` p <br /> DESC. ToZS^ 37'f�eZ( O�� <br /> OWNER ADDRESS CITYIZIP PFiONE <br /> SLcSaH l�c.vmli.� y73� Y(el-,�+�f PI ��ere�1 kl.� 9�aa3 <br /> TENANT NAME I CONTACT FOR PERMIT � P ONE <br /> CONTRACTOR ADDRESS C�TY21P PHONE <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRI.CE OF WORK <br /> �- -, � Eleclric Gas Other <br /> �� l fc — — — <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC–air handling unils <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Cbthes washer _ Clolhes dryer <br /> Waler healer Range hood <br /> �,._ Sink(servicelbadmop/elc.) _ Exhaust(an <br /> Backfiow preventer _ Heal pump <br /> Urinal Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Groase trap _ Woodstove <br /> Roof drains Other _ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE�S 3105 <br /> I hereby ceritify lhal I have read and examined this application and know lhe same to be lrue and cortecl. All provisions of laws and <br /> ordinaces governing Ihis type oi work will be complied with whelher specified herein or not.The granting of a permit does not presume <br /> to give aulhority to violale or cancel lhe provision of any other slate or local law regulating construction or the peAurmance of <br /> construction.Thal I am authorized by lhe owner of this property to pedorm the work tor which applicatien is made and I comply with the <br /> State Conlr ctors Law 18.27 RCW and 296.200 WAC. <br /> �� � _ �-'j��„�_ //- za -Dj, <br /> Sig alure o(OwnedContractor/Authorized Agenl Date <br />