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F��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.everettwa.org i� ` � _�J <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS rYi � P C TAl(I.D.X � � PERMR A _ <br /> LEG LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER � • ADDRESS ITY21P PHONE <br /> 1 l� , 1 . _�.D � � <br /> TFNANT NAME TAFT FOR PE MIT PNONE <br /> � I �� =-l� -�l <br /> CONTRACTOR ��vYv-�!1 ('Q'\�CO ;��5�� �•CITY2IP PHONE <br /> 1 � 1 lJl.� +w <br /> CONTR.LICENSE# I 1 r a�� � � J{J�'l�Z� <br /> l IG�1`� ��1 D1.7 J <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��� _Eleclric�Gas_Other � <br /> WORK DESCRIPTION 1 ���.�(\�� � ` �'\ 1 ���^(�(�� <br /> \ 1.,L �.� C� \ 1 j�-C> `� <br /> a,�d, a�a� �-�g��u�,s � di <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7URE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> _ Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Ciothes washer Clolhes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/mopletc.) � Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeradon <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriU(y that I have read and examfned lhis applicaUon and know the same to be true and cortect. All provisions oi laws and <br /> ordinaces goveming lhis type of work will be complied with whether specified herein or not.The granting of a pertnit dces nol presume <br /> to give authority to violate or cancel lhe provision of any olher state or local law regulaGng construction ur the perfortnance of <br /> �onstruction.That I orized by the owner of lhis property to perfortn the work for which application is made and I comply with the <br /> le ntracfors L 182 RCW a 96.200 WAC. <br /> lb�2C�� �� <br /> Signa o Ownerl ontraclod th rized gent Date <br />