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PERMIT APPLICATION <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 <br /> SITE ADDRESS I PARCEL TAX 1.6.# �ERMIT# <br /> S O 2 D/� w pol� - O ��— <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> / CONTACT FOR PEk�AIT PHONE <br /> TENANTNAME q p��qN�eD �L '/ 3G� �+� I ZV� 3 <br /> Vfi��� �2�L�NOLO��I 5��'" � RC��`• E-MAIL <br /> L�6N � / Ao RES <br /> CONTR.LICENSE# ��� P/�� <br /> USE OF BUiLDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas_Other �� Q06 � <br /> WORK DESCRIPTION <br /> �j IS � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 'L Toilel A/C—air handling units <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> 1 Kitchen sink R disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> 1 Clolhes washer Clothes dryer <br /> 1 Water heater Range hood <br /> � Sink(service/bar/mop/etr..) _ Exhaust fan <br /> BackFlow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease tc;p _ Woodstove <br /> Roof drains Other <br /> 1 other TRAP ��EliNta <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> I hereby certity thal I have read and examined this application and know the same to be lrue and correct. Ali provisions of laws and <br /> ordinances governing this type of work will be complied wilh whether specified herein or not.The granting of a pertnit does nol presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or ihe perfotmance of <br /> construction. hat I am authorized by the owner ef this property to perform the work for which application is made and I comply with the <br /> State Contr tors L 18.2%RCW and 296.200 V`JAC. <br /> L - l�(- / 0 <br /> Signa ure of Owner/Contra�tor/Au�horized Agent Date <br />