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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 />LEGALI. LOT. NO. BLOCK TR <br />DESC. . _ _ s- <br />NERR CITY/ E <br />-O�W+ <br />✓1 /J / <br />ilo�/ /� �i���'i�_�G'CJ' 1`.�� �X��� �j�.�1/�� �t�/�S �i� �,��/��- � ��✓•-%C�� ®� <br />TENANT NAME <br />CONTRACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />/9.4 J�feltsa <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <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 />Toilet <br />A/C —air handling units <br />Bathtub <br />I <br />Forced air systems <br />bfi <br />Lavatory (wash basin) <br />Gas piping <br />g <br />Shower <br />! <br />Water heater <br />f <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water heater <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 />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 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 Contr ctors Law 18.27 RCW and 296.200 WAC. <br />Signa re of Owner/Contractor/Authorized Agent Date <br />