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PcRMIT APPLICATIUN <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--0'(0 <br />SITE ADDRESS PARCEL TAX I.D. # RMIT # <br />LEGAL LOT NO. BLOCK TRACT <br />UESC. <br />OWNERD/L <br />�'(��CHONE <br />Cil r W�l/�(A �i �,1A'IIJIIT G) AVE aC"[�l�ll 9�Z�_�(2 'r <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CND 1`10aisu�.' <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />LJ`N vlV <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />� <br />_Electric _Gas _Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. 'TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C —air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_Clothes <br />dryer <br />Water healer <br />_Range <br />hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />_ <br />BackOow prevenler <br />Heat pump <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />_Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby rerility that I have read and examined this application and know the same to be true and correct. All provision= of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of permit does not presume <br />to give authority to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br />construction. That 1 cm authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Sta e'� lra for 296.200 WAC. <br />118.27�CW�� �and <br />` <br />Signature of Owr�er/Contractor/Authorized Agent Date <br />