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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 AJXIRESSA <br />PARCEL TAX I.D. # <br />KRMIT # <br />AL LO O. <br />BLOC <br />TRACT <br />SC. <br />0 <br />R ADDRESS CITY/ZIP PHONE <br />-Or/l2 L-�20.'6'x � cif &XAXJ))� " <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITY/ZIP PHONE e <br />CONTR. LICENSE # �....t.' T1; •. E i i_`-. ' a <br />� S!- 78�7 <br />i <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Gas Other <br />WORK DESCRIPTION�� <br />PLIJIMING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C — air handling units <br />Bathtub <br />_ <br />Forced air systems <br />Lavatory (wash basin) <br />_ 4 <br />Gas piping <br />Shower <br />I <br />Water heater <br />Kitchen sink & disposal <br />�_ <br />Gas fireplace <br />Dishwasher <br />Gas range. <br />Clothes washer <br />Clothes dryer <br />Water heater <br />I_ <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 />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 />construct' . 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 Co tractors aw Aa d 296.200 WAC. <br />Sig ure of er/Co tractor/Authorized Agent Date <br />7 <br />