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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 NM C;.-a5'—p a <br /> SI ADDRESS PARCEL TAX I.D.# PERMIT p <br /> -' ,���� -,� �r�=1 �,�,� mc��o�-a�13 <br /> .:,i LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> .'1WNER ADDRESS CITY/ZIP PHONE <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> CONTRACTOR ADD ESS CITY/ZI <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric Gas Other <br /> WORK DESCRiPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURL OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhlub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Sho�ver Waler heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler healer Range hood <br />� _ Smk(servicelbadmop/etc.) � Exhaust fan <br /> BackOow prevenler _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain _ 6oiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby cerilify lhat I have read and examined lhis application and kcow the same lo be true and correcl All provisions of laws and <br /> ordinaces goveming lhis type of work will be complied wilh whelher specified herein or not.The granting ot a permit does not presume <br /> to give authority to violate occancel the provision of any oUier state or local law regulating construction or lhe pertormance o( <br /> construction.\Thal I am.aulhorized by the owner of thio property lo periorm the work for which applicalion is made and I comply wilh lhe <br /> Stat onir� Iprs Law 18.27 RCW and 296.200 WAC. <br /> 1 �� <br /> S� ture of 0� edContractodAuthorized Agent Date <br />