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P�RMIT APPLICATILN <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 iYRE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARUS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ;'/�// / -SC � �°� �( '� - D <br /> LEGA LOTNO. BLOCK 7RACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONF. <br /> /��k,u�� <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> � Lo�� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# �/ � �/��— <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> .-�/� Z/ � � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEE7 I <br /> �� Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> �� Lavatory(wash basin) Gas piping <br /> Shower 1 Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> I Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> Foof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> iI hereby ceriti(y lhat I have read and examined ihis 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 of any olher state or local law regulating construction or the performance of <br /> � construction.That I am authorized by the owner of this pmperty to perform lhe work for which application is made and I comply with the <br /> State Con racrors Law 18.27 RCW and 296.200 WAC. <br /> , ,'! 1'9 S ��' I ' D�l <br /> � Signature of OwnedCon actodAuthonzed Agent Date <br />