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�RMIT APPLICATI�N <br /> CITY OF EVER�TT 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 E AM TO 4 PM <br /> SITE AD RESS �J PARCEL TAX I.D.�1 PERMIT R <br /> /" G< < �'�� ���J ' 00.�- <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> OWNER ADORESS CITY2IP PMONE <br /> TEHANT NAME CONTACT FOR PERMIT F HONE <br /> EdAAiL <br /> CONTR.LICENSE� L JUJ^{<,_� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��� � _Electric _Gas_Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7URE OR ITEM <br /> Toilel _ p✓C—air handling units <br /> Bathtub _ Forced air syslems <br /> f Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Ga,range <br /> Cbthes washer _ Cbthes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) � Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease lrap _ w�dstove <br /> Roof drains Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS�105 <br /> I hereby ceritify that I have read and ezamined this applicalion and know the same to be true and cortect. All provisbns of laws and <br /> ordinaces goveming this type oi work will be complied with whetl�er specified herein or not.The granting of a pertnit does�ot presume <br /> to give aulhority to violale or cancel the provision of any olher slale or local law regulating construction or the perfortnance of <br /> construclion.Thal I am authorized by the owner ai this property to perform the work for which application is made and I comply with the <br /> State Co ilr ct9rs L � 18.27 RCW and 296.200 WAC. <br /> � - • D <br /> Signature of OwnedContra r/ uthorized Agenl Date <br />