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i <br />P.-RMIT APPLICATIC,N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, OVA 98201 <br />425-257-8810 —FAX 425-257-8857 — www.everettwa.org —C <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 />PFrRMIT # <br />90l G/au,teG lJitlu2 <br />LEGAL LOT NO. <br />` BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE <br />/ q <br />%B/� %1 <br />//%i/iNK /✓Zl/ <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORM; <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 <br />air systems <br />_ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />_Gas <br />fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />_ <br />Laundry tray <br />Range hood <br />Sink (service/bar/mop/etc.) <br />_Exhaust <br />tan <br />_ <br />Backflow prevenler <br />_Heat <br />pump <br />Urinal <br />_Unit <br />heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floordraln <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 of 05 <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 />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 298.200 WAC. <br />Signature o OwnerlCont ctor/Authorized Agent Date <br />