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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 />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />I <br />G-,�-) 4�-leS s l n�4 aka-& - —r L .%— <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />-2LI3-IZtlir <br />CONTR. LICENSE # <br />FAX <br />USE OF BUILDINP <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric --Gas _ Other <br />WORK DESCRIPTION <br />IZR,55 ��teC,) 7 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />3 <br />Toilet I I / <br />A/C — air handling units <br />_P.,, <br />Bathtub // <br />1�_ <br />Forced air systems <br />L_ <br />Lavatory (wash basin) <br />Lj <br />Gas piping -- <br />Shower <br />t <br />Water heater <br />4 <br />i <br />Kitchen sink & disposal <br />Dishwasher <br />I <br />t <br />Gas fireplace / <br />Gas range <br />t <br />Clothes washer <br />Laundry tray <br />I <br />t <br />Clothes dryer <br />Range hood <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 />Refrigeration <br />Grease trap <br />Roof drains V <br />Woodstove <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,l 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 />Signature df Owner/Contractor/Aut rized Agent Date <br />