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�— <br /> PE; :MIT APPLICATIO� � <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 /> �—p5 — O � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> //�S �w� ,,�(;,! .r� �_�� �- � ; v �����o� rv�o �o�-oo <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ��•r /�,. r� /'r.iig � sr�� ��. .i� .;,�%o,,, r�l, pgZ96 �1�,333�.3,�0 <br /> TENANT�AME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE X <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /� � Electric �Gas_Other <br /> /\ P�. i,:1t;✓ 'id — <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. 1YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub � Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower � _� Water heater <br /> Kitchen sink 8 disposal t�o as fireplace <br /> � Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> i Sink (service/badmop/eic.) _ Exhaust fan <br /> Backflo�v preventer Heat pump <br /> Unnal Unit heater <br /> ' �nnking Fountain _ Boiler <br /> I Floor drain Refrigeretion <br /> i �rease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> i _ i <br /> i CIIY OF EVEREP :AL SALES TAX COOE IS 3105 <br /> i - <br /> ; I hereby r.eritify that I have read anA examined thi� ap; and know the same to be true and correct. All provisions of laws and <br /> ' ordinaces governing th�s rype of�.verk�vill be coripiie �ether specified herein nr not The granting of a permit does not presume <br /> ' to give authonty to vioiate or cancel the provision of er state or local law regulating wnstruction or the performance of <br /> construction. That I am authorized by the owner�f �oer!y to periorm the work for whlch application is made and I comply with the <br /> State Contractors Law 18.27 RCW a�nd��6.200 lb <br /> ' � ���/ �/�=��-/- <br /> I n�`.�,..i �'1 i7��i <br /> � Signawre of u'wnen q ractor�Authonzed Hgeni Date <br /> I ' <br />