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r— <br /> P�r2MIT APPLIC/�T�a�� <br /> CITY OF EVERETT PERMIT SE`:dICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org �.// D/� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE AD RESS � PARCEL TAX I.D.# PERMIT# <br /> (� �S -S ��7-6z <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CUNTRACTOR ADDHESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eiectric Gas Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYP'e OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas pipiny <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hoad <br /> Sink(service/bar/mop/etc,) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap , Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVEREiT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision af any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by Ihe owner of lhis property to perform the work for which application is made and I comply with the <br /> � Stat Co hactor aw 18.27 RCW and 29E.200 WAC. <br /> � <br /> I <br /> � /!'J I <br /> I Si ure Owner/ ontractor/Authonzed Agent Date <br /> I <br />