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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8610- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 -17-0� <br /> SI'fEADDR�SS P CELTA%I.D.N PERMITii <br /> y�l � � � 1��11� r '' 0 M v v <br /> LFGA L T NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER AUORESS CITY2IP PMONE <br /> �.�-�11��t/ Y1C'`(�f � C' � . -�17• , <br /> TFNANT NAME CONTACT FOR PEHMIT ��l�QN, �L I_��� <br /> �����Cl��(� ;y� <br /> e�a� <br /> CONTRA T ������,/����i��� �� E ° � � � � ITY I PH N <br /> c <br /> CONTR.LICENSE��I` 1` 1 \�VI Y I I � � 1.�� � <br /> USE OF BUILDING HEAT S CE CONTRACT PRICE OF WORK <br /> 11r,1 \ � � ��ecinc ". _Gas__Other I 3k�� �� <br /> 11.1.J1 1. <br /> WORK DESCRIPTION � <br /> %'c ��-r-�- r �—� <br /> � PLUMBING MECHANICAL <br /> TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel lVC—air handling unils <br /> Ihtub � Forced air systems <br /> La lory(wash basin) Gas piping <br /> Sho Water heater <br /> Kitchen 'nk 8 disposal Gas fireplace <br /> _ Dishwash Gas range <br /> Clothes wast _ Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mo tc.) Exhaust fan <br /> Backllow prevenler Fieal pump <br /> Urinal Unit heater <br /> Drinking Fountain �Boiler <br /> Floor drain Refrigeration <br /> Grease Irap Woodstove <br /> Rool drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL S LES TA%CODE IS 3105 <br /> I hemby cerilify thal I have read and eaamined this application and know�he same to be irue and correct. All provisions ol Iaws and <br /> ordinaces goveming Ihis type ol work will tre cortiplied with whether specified herein or noL The granting of a permi�does not presume <br /> to give authority�o violate or,:ancel Ihe provision ol any oiher slate or local law regulating constmction or Ihe pedorman^e ol <br /> consVuction.That I am authorized by�he owner of lhis property to pedorm the work tor which application is made and I comply with ihe <br /> IStale Contractors Law 1827 RCW and 296.200 WAC. <br /> ISignaWre ol Owner/Contrac�oVAuthorized Agent Date <br />