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.'ERMIT APPLICA'o �ON � <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEEIT&CREDIT CARDS ARF_ NOT ACCEPTED <br /> SITE AD ESS PARCEL TAX I.D.# PERMIT# �, <br /> �/i ' -S�G� Sz� _S� t�S��� - /y <br /> LEGA LOTNO. BLOCK TRACT <br /> DEBC. ,_�/ I <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> � i� I <br /> TENANTNAME CONTACTFORPERMIT PHONE ' <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# 9 � � � <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br /> ��� _Electric _Gas_Other <br /> WORK DESCRIPTION <br /> ,(� I�('�! n C�(.��d r—/� ��� // <br /> PLUMBING MECHANIC�`L <br /> N0. TYPE OF FIXTURt OR ITEM NO. TYPE OF FIXTURE 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 /> Clolhes wssher Cblhes dryer <br /> Laundry tray Ranye hood <br /> Sink(service/bar/mop/etc.) Exnaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Greasetrap �voodstove <br /> Roof drains C!hor <br /> Other <br /> — —I � <br /> CIN OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined lhis application and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces governing this rype of work will be complied wilh whether specified herein or nol.The granting of a permit does not presume <br /> lo give authoriry to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construclion. That I am aulhorized by the owner of this property to perform lhe work(or which application is made and I comply wilh the <br /> Slate Contractors Law 1827 RCW and 296.200 WAC. <br /> SignaWre of OwneqContractodAuthorized Agent Date <br />