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r <br />F `RMIT APPLICATIvN <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 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />LEGAL LOT NO. <br />CK <br />TRACT <br />,D�LjO <br />OWNER —,ADDRESS CITYIZIP PHONE <br />TENANT NAMr_ <br />CONTACT FOR PERMIT PHONE,70b — <br />I <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />�y /� <br />CONTR. LICENSE # /���� C ✓ <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric Gas Other <br />WORK DESCRIPTION <br />/ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C —air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />_ <br />_ <br />Laundry tray <br />Range hood <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit healer <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />_ <br />Otner <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 />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 authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That 1,pq authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State ntractors .aw .27 RCW and 296.200 WAC. <br />5 <br />Si nature f O ner/ tractor/Authorized Agent D to <br />