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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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <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 />t-1 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />I <br />Less( '-M5-`74-!S-[`10? <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />-A cQ &CvR <br />CONTR. LICENSE <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�v <br />_Electric Gas _Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />5 <br />Toilet <br />A/C — air handling units <br />A <br />Bathtub �j <br />�_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) % <br />_t <br />Gas piping <br />Shower <br />l <br />Water heater <br />Kitchen sink & disposal <br />I <br />Gas fireplace <br />t <br />Dishwasher <br />I <br />Gas range <br />t <br />Clothes washer <br />_ I <br />Clothes dryer <br />Laundry tray <br />t <br />Range hood m,eR-v <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />�_ <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 />I 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 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. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signatur of Own er/Contract)/Authorized Agent Date <br />