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PLRMIT 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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />IWL S.C. Wa <br />LEGA LOTNO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />&agtjo-r W;rrQess <br />Alndm,,) g <br />CONTRA TOR ADDRESS WA n � h1L� 5CITY2IP•PHONE <br />�LiZri� <br />. Edwtoa> �L�D%O 77l{- <br />CONTR. LICFWQE # + <br />l,.Jlt_COL �I'ikQo � 1� <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I — Electric Gas Other <br />4 <br />I <br />WORK DESCRIPTION i <br />i <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <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 />Water heater <br />_Shower <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />Clothes washer <br />_ <br />Clothes dryer <br />Laundry trey <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />_ <br />U. let <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />_ <br />Roof draLis <br />Other <br />Other <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that I have read and examined this application and know the same to be true 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 />State Contractors Law,18.27 RCW and 296.200 WAC. <br />as / /L/OS <br />/.�X <br />Signature of Owner/Contractor/Authorized Agent Date <br />