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F A.:RMIT APPLICATIvN <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 - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.k PERMIT p <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS 1 21P PHONE <br /> <) sA =r.+.r Lrnl - N..'LnTH sT,TXT iNurrr izNE `I�d 13t �,c B33 �) ) <br /> TEINANTNAMEI CONTACTFOR PERMIT PHONE <br /> _ NSR/'.wu% n fNEr l-�/ Draz a NFuIIP+tci2 'DI)L.- 7r"E U4riq <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> 'pv 3x 116h Wpoozwvxa�E� WA 98 16 <br /> CONI H.LICENSE 0 <br /> S tq�266'IA <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other <br /> WORK DESCP.IPTION <br /> l�p0 (3) p.IfFos.EeS .—a ��ss=j-,v� ,DvaT Sys�Ee.-, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE 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 Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry trey Range hood <br /> _ Sink(servicefbar/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 EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cedtify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinates 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 law regulating construction or the performance of <br /> construction mal I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Stele Co f gclors Lew 18. CW and 2 .200 WAC. <br /> tine ure of Owner/Contractor/Authoriziadgent ate <br />