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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 DDROSS P RCEL TAX I.D. # PERMIT # <br />'�71 O ltul -OeV-,- <br />LEGAL] LOTNO. BLOCK TRACTOR SUBDIVISION # _ - . <br />DESC. lq— uo �----�� <br />OWNER ADDRESS CITYIZIP PHONE <br />TENANT NAME <br />CONTACT FOR PER IT PHONE 725Z 4Z 11-7 s9 <br />I L E-MAIL _ <br />7---- 21 PHONE <br />CONTRACTOR w�S ADDRESS' <br />CONTR. LICENSE # <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />_Electric _Gas _(Ater �'�/Zgr.-Ctf D <br />WORK13SCRIPTION <br />/ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — air handling units <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water heater <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />_ <br />Roof drains <br />_ <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 wiln 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 pe rm the work forwhich application is made and I comply with the <br />Co tors Law 11.11 RCW and 296.200 WAC. / <br />7 OW iAlb14 !!7 <br />Signal re of ner/Contractor/ rmonzed Agent <br />