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PERMIT APPLICATION <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 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />Ari 4 U0%AAF,s `� �0 1S%-rfi ST S,�. _ 4-330,E I i`t. <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # � � �0 2—CE <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />1'A E1 5:F- <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION <br />4 <br />Woe?. �I CC <br />PLUMBING <br />MECHANICAL, <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />'3 <br />Toilet <br />A/C — air handling units <br />Z <br />Bathtub 1 I <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />1 <br />Shower i / <br />• � 2— <br />Water heater p <br />_ <br />Kitchen sink &disposal <br />I <br />Gas fireplace <br />6 <br />Dishwasher <br />i <br />Gas range <br />I <br />Clothes washer <br />= <br />Clothes dryer <br />Water heater <br />✓ <br />I <br />Range hood <br />Sink (service/bar/mop/etc.) <br />ate' <br />Exhaust fan, y`1 <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 riot. 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. That I ab authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State C ractor La 18.27 RCW and 296.200 WAC. <br />-m-� <br />Signature of Ow er/Contractor/Authorized Agent Date <br />