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F RMIT APPLICATItiN <br />FcRMIT APPLICATIt�N <br /><I 0 EVEPE SERVICES <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-8857 — www.evere![wa.org <br />ARE ACCEPTED FROM 8 AM TO 4 PM <br />�{APPLICATIONS <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMITk <br />��s ��. GAsy�rn <br />A � I <br />uo <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />Br�l <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE I/ <br />EMAIL <br />CON R. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />o- <br />CONTRACT PRICE OF WORK <br />IM �j <br />_Electric _Gas _Other <br />J <br />G So d <br />I <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 />Forced air systems <br />Lavatory (wash basin) <br />_Gas <br />piping <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ _ <br />Exhaust fan <br />Backflow pr;wenter <br />Hoot pump <br />_ <br />Urinal <br />_Unit <br />heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <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 cerilily that I have read and examined this application and know the same to be hue and correct. All provisions of laws and <br />ordinates 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 />Stale ontractors Law 18.2yRCW and 20.200 WAC. <br />�/ — /, <br />Signature of Owner/Contractor/Authorized Agent Date //2 <br />y <br />