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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-3857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS t <br />PARCEL TAX I.D. # <br />PERMIT # <br />- <br />5F-, <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OWN. ER i ADDRESS CITYIZIP PHONE <br />TENANT NAME CONTAC FOR PERR T PHONE <br />�_C[ZL(— 1325 <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE # V -,e r sa633 eY IF — <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />LC,�C- /0� ( I _Electric —Gas —Other <br />[[[�CCSS LV� [r^� �e�DktCe lvl �t 1n US.rI sl��n��e <br />MORKDESCRIPTION <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />— <br />A/C — air handling units <br />_ <br />Bathtub <br />— <br />Forced air systems <br />Lavatory (wash basin) <br />— <br />Gas piping <br />Water heater <br />_ <br />Shower <br />Kitchen sink & disposal <br />— <br />— <br />Gas fireplace <br />_ <br />_ <br />Dishwasher <br />Clothes washer <br />— <br />— <br />Gas range <br />Clothes dryer <br />_ <br />_ <br />Laundry tray <br />Sink(servicelbar/mop/etc.) <br />_ <br />— <br />Range hood <br />Exhaust fan <br />_ <br />_ <br />Backfiow prevenler <br />— <br />Heat pump <br />Unit heater <br />_ <br />_ <br />Urinal <br />Drinking Fountain <br />— <br />— <br />Boiler <br />Refrigeration <br />_ <br />Floor drain <br />Grease trap <br />— <br />— <br />Woodstove <br />_ <br />_ <br />Roof drains <br />— <br />Other <br />Other <br />— <br />I <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify 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 />the for which application is made and I comply with the <br />construction. That I cm authorized by the owner of this property to perform work <br />State Contractors Law 16.27 KW and 296.200 WAG. <br />I C`_.'—CDS <br />Signature o Owner/Go ctor/Aut onzed Agent Date <br />