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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR ��REET, EVERETT. VVA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �I �- a —O� <br /> SITE ADJI SS PARCEL TN(I.D.p l P RMIT A' <br /> < < _ a I /�'l�C�/1C%% <br /> LEGA LO?NO. BLOCK TRACT OR SUBDIVISION ft � <br /> DESC. <br /> OWNER AGDRESS CITYIZIP PNONE <br /> ' L�.. ) � � <br /> TENANTNAM _ CONTACTFOR PERMIT PHONE <br /> E-MAIL <br /> p I / P <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electnc Gas Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE C)F FIXTURE OR ITEM NO. TYPL OF FI%TURE OR ITEM <br /> Toilei A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavalory (wash basin) Gas piping <br /> Shower ater healer <br /> Ki�chen sink 8 disposal _ Gas tireplace <br /> Dishwaslier Gas range <br /> Clofhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/badmop;elc.) Exhausl fan <br /> Backflow preventor Heal pump <br /> Urinal Unit healer <br /> _ Drinking Fountain _ 8oiler � � <br /> _ Floordrain Refrigeration ���';y� <br /> _ Grease lrap _ Woodstove 4n(� ; U' <br /> RoofArains Other /� /�� „1 ���I <br /> _ Other _ i V Il' <br /> _ _ �� �� !� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i hereby ceriti(y that I havo read and examined this application and know the same to be true and wrrect. All provisicns oi faws and <br /> ordinaces governing this typo of work will be conplied with whether specified herein or not.Th�granting o(a permit does nol presume <br /> to givo authority lo violale or cancel the yrovision of any other slale or local law regulating cons.ruction or the periormance of <br /> conslrucfion.That I am authorized by the owner ol Ihis property to periorm fhe work for which application is made and I comply with the <br /> Stale Conlractors Law 18.27 RCW and 296.200 WAC. <br /> Signaluro of OwnerlContractorlAuthonzed Agent D�te <br />