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PE�IMIT APPLICATI(��J <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LEGA L07 N0� <br />DESC. <br />OWNER <br />TENANTW E �x� <br />� C.�(� \ V� � <br />CONTRACTOR <br />CONTR. LICENSE / <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. � TYPE OF FlXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothea washer <br />Laundry Vay <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />PARCEL l �X I.D. N <br />TRACT <br />CONTACT FOR PERMII <br />ADDRESS <br />HEATSOURCE <br />_ ElecUic _ Gas _ Other <br />{�e I` <br />CITYlZ�P <br />PHONE <br />CONTRACT PRICE OF WORK <br />NO. � TYPE OF FIXTURE OR I7EM <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 />Refigeratian <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 7105 <br />I hereby ceritify that I have read and examined this applicaBon and know the same to be true and cortect. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The grantlng 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 perfortnance of <br />construction. That I am authorized by the owner of this property ta perform the work for which applicadon is made and I comply with the <br />State ConUactors Law 1827 RCW and 296.200 WAC. <br />Signature o Owner/ContractorlAuthorized Agent at�— <br />