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�r'ERMIT APPLICAI iON <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 />C J <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />TEN6,NTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT FOR PERMIT <br />ADDRESS <br />CITY/zIP <br />PERMIT # <br />PHONE <br />PHONE <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric Gas Other 1 <br />r�k <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ Toilet <br />Bathtub <br />_ Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink & disposal <br />_ Dishwasher <br />_ Clothes washer <br />_ Laundry tray <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 />NO. <br />FIXTURE OR ITEM <br />A/C —air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />ClWhes dryer <br />Range hood <br />Exhauatfan <br />Heat pump <br />Unit heater <br />Boile <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 />ordinaces 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 a fhority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That 1 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 />Signature o` Owner/ContractortAuthorized Agent Date <br />