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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 PARCEL TAX I.D.# P MIT# <br /> �/;�; �� `> `� {�V (�' L �, � � � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE G <br /> . , , - . , � • ,- fJ <br /> � � <br /> %� ��.- � � � ;.�� l�r''� � �'� � �� �-..-.�� �� �_� <br /> ���� � )( j��l l. �i�����)�f � �� � f ����'�����f�, ��� /� ��� � <br /> TE ANT NAME CONTACT FOR ERMIT PHONE <br /> E-MAIL <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR. LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> � � �z � ��, �� �aS� la--G�3J <br /> K_� <br /> , �- � ' �'CY C�-�� �'����(S C � <br /> ��a� ��r,C�}�i C?�< C �-= - <br /> i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink &disposal Gas firepiace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink (service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances 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 296200 WAC. <br /> Signature of Owner/Contractor/Authorized Agent Date <br />