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<br />- PERMIT APPLICATIO ,�IV � pPR 2 3 2012 �l�
<br /> C I T Y O F E V E R E T T P E R M I T S E R V I C E S
<br /> 3200 CEDAR STREET, EVERETT, WA 98201 C�� �t;� �, � � ;, �,. ,
<br /> 425-257-8810— FAX 425-257-8857—www.everetiwa.org '
<br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM y�. a(,F���
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<br />��.�` � � SITE ADDRESS PARCEL TAX I.D.# PERM�T#
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<br /> LEGA LOTNO. BLOCK TAACTOR:UBDIVISION#�
<br />�-,.=� DESC.
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<br /> OWNER ADDRESS CITY2IP PHONE
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<br /> TENANTNAME � ONTACTF RPERMR� PHONE ���y'��� 6J� �
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<br /> CO TAACTO � ADDRESS ��,�`/I n���, c �1�Ty21P PHONE i}�{ ��.y_ CII� �
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<br /> CONTR.LICENSE ��g
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<br /> USE OF BUILDING HEAT SOuRCE CONTRACT PRICE OF WORK
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<br /> t• r e,� Electric � Gas Other � �C �
<br />�,.,� ', WORK DESCRIPTION
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<br /> PLUMBING MECHANICAL
<br /> NO. TYPE OF FlXTURE OR I'fL-M NO. TYPE OF FlXTUflE OR ITEM
<br /> _ Toilet A/C-air handling units
<br /> _ Balhtub Forced air systems
<br /> _ Lavatory(wash basin) Gas piping
<br /> _ Shower � Water heater �
<br /> _ Kitchen sink&disposal Gas fireplace
<br /> _ Dishwasher Gasrange
<br /> _ Clothes washer Ciothes dryer
<br /> _ Water heater Range hood
<br /> Sink(service/bar/mop/etc.) Exhaust lan
<br /> _ Backtlowpreventer Neatpump
<br /> jF"TM�,� _ Urinal Unitheater
<br /> rvr.;. ; _ Drinking Foun�ain Boiler
<br /> '��� �i _ Floor drain Refrigeration
<br />�`"�'" Grease trap Woodslove
<br />:"�-�^='I Roofdrains Other
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<br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105
<br /> I hereby ceriti(y ihat I have read and examined Ihis application and knowlhe same to be irue and correcL All provisions of laws and
<br /> ordinaces goveming lhis lype of work will be complied with r�ether specified herein or not.The yranting of a permit does not presume
<br /> to give authoriry�o violate or cancel the provision ot any olher state or loral law regWating construction or the pedormance of
<br /> constmction.That I am authorized by the owner of this property to pedorm the work lor which application is made and I comply with the
<br /> State Coniractors I�w 78.27 RCW and 296200 WAC. n �'
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<br /> ignature of Owned ontract AGthorized Agent Date ` C'�'t��-�r t��
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