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PL�tMIT APPLICATIO��! <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CF_DAR 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 - DEBIT 8�CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMIT# <br /> / ,ati� S� D � U�'-LL' <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP Pl10NE <br /> /��Gt i��i�u� j4va�?c /i�vc y�«.�r;S <br /> �T' NT NAME CONTACT FOR PERtd1T PHONE <br /> 7� �.rlJ/cSs I -�cv�r T4�-o�zS�.� �fz� 75 Y �C��- <br /> CONTRA�� f1��,y�,G� y�� ADOfjE�� �0.� �,� R .,UFCI'Yf11P PHONE <br /> d �i'' <br /> CONTR.LICENSE# l Ciry�.$ J:��z- / G`� ,�4� �3S ySS�� <br /> `J—L r P�L C3!!SC"r U �:>�� ��Il� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> v_ <br /> _[Iectric _Gas_Other ��QU <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF F� 'TURE OR ITEM NO. TYpE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> _ Kitchen sink 8 disposal �- Gas fireplace <br /> _ Dishwasher �- Gasrange. <br /> Clothes washer Clothes dryer <br /> Laundry tray -- - - <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 /> j � Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> I i — — <br /> I I <br />� i CITY OF EVERETT LOCAL SALES SAX COOE IS 9105 <br /> I <br /> i <br /> II hereby ceritify ihat I have read and examined this applicatlon 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 of any other state or local iaw regulating consiruction or the performanr,e of <br /> � construction That I am authorized by the owner of this pmperty to perform the work for which application is made and I comply with the <br /> State Con ctors Lay��27 RCW and 29fi.200 WAC. <br /> I / <br /> � �ir ��I '✓�--- �—/D—Ll� <br /> I9ignature oi Owner/Contractor/Authorized Agent Date <br /> I I � <br />