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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 0I44ONE <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />G <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_ Electric Gas _ Other <br />f / <br />WORK DESCRIPTION <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 <br />A/C —air handling units. . • . <br />2 <br />Bathtub <br />! <br />Forced air systems <br />U <br />Lavatory (wash basin) <br />Gas piping <br />/ . <br />Shower <br />/ <br />Water heater <br />Kitchen sink& disposal <br />! <br />Gas fireplace <br />1 <br />Dishwasher <br />/ <br />Gas range <br />/ <br />Clothes washer <br />Laundry.tfay sir✓/c <br />/ <br />/ <br />Clothes dryer <br />Range hood <br />Sink (service/bar/mop/etc.) <br />-` :i <br />Exhaust -fan <br />Backflow preventer <br />' T <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 31,05 <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.ornot. 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 />Signature of Owner/Contractor/Authorized Agent Date <br />