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P�RMIT APPLICATI�,N � �( <br /> CITY OF EVERETT PERMIT SERVICES P 1 <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 - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PER IT# <br /> ��4�� ��� �e � � � �� <br /> LEGA LOTNO. BLOCK TRACT <br /> UESC. <br /> OWNER ADURESS CITY2IP PHONE <br /> CX.L�CJW �V, <br /> 'T�If�{��"�U��G �� I C�NTAC�RMI2�r..o✓� � � Pj�-��.,,i . � p_ L I <br /> �v�p�G�� --ra�C/v��� '1 0 <br /> l V � <br /> CONTRACTOR AI:;:RESS CITY2IP PNONE <br /> coNrap ic���_ �2P �° � �`�v'S �SP•c.{,�f£�7Z�?J <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other (,��Q� <br /> WORK DESCRIPTION <br /> I I <br /> PLUMBING MECHANIC:L <br /> N0. TYPE OF PIXTURE OR ITEM NO. TYPE OF FIXTUPc OR ITEM <br /> _ Toilet A/C—air handlirg units <br /> _ Bathtub Forced air�,�tems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Waterheater <br /> _ i<itchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> Clothes washer � Clothes dryer <br /> _ Laundry trey Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> Drinking Fountain 8oiler <br /> I � �loordrain = Refrigeration <br /> Gre;se trap Woodstove <br /> Roof drains Other <br /> i _ Other _ <br /> I _I I <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined!his application and know the same to be true and correct. All provisions of laws an� <br /> ordinaces governing this type of work will be complied with whether specified herein or noL The granting of a pertnit does not pr��sume <br /> to give authority to violat or cancel the provision of any olher state or local law regulating construction or the performance of <br /> i constructio . u h rized by the owner of this property to perform the work for which applicatlon is made and I comply with the <br /> I State Co tra o 8 , nd 296200 WAC. <br /> �2�z-o4 � <br /> ISignature of ntractodAuthonzed Agent Date �L <br /> I <br />