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low <br />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 PARCEL TAX I.D. # P R # <br />00 <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION # DESC. a , �©1 _r�(,D I ir- k� /1\ i i - .��t A � n <br />TENANT NAME CONTACT FOR PERMIT <br />ePr6 Z 6645tr­ t4 cW&J, I A IG, - <br />CONTR. LICENSE # , <br />USE OF BUILDING <br />HEAT SOURCE <br />s I _ Electric _k Gas —Other <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM I NO. <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />t <br />Kitchen sink & disposal <br />Dishwasher <br />f <br />Clothes washer <br />i <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />_ <br />Roof drains <br />Other <br />PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <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 />Signature of Owner/Contractor/Authorized. Agent Date <br />