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APPLICATION <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT PERMIT <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />�z.zn.re��-rv�a:. zn.ee.�_........�ni.a.A <br />425-257-8810 —FAX 425-257-8857 — vYww.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM (� <br />SITE ADDRESS <br />PARCEL TAX I.D. p <br />PERMIT <br />i � <br />X D <br />T�oanoxxm��+.anae�wm.��.�o�m <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION # <br />i DESC. <br />rrr .sue .�...i. <br />OWNER ADDRESS CITYIZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />EMAIL <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE p <br />USE OF BUILDING I <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_Electric _Gas _Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />III <br />NO. TYPE OF FIXTURE OR ITEM <br />�.ww�m <br />NO. TYPE OF FIXTURE OR ITEM <br />� <br />Toilet <br />A/C -air handling units <br />Bathtub <br />Forced air systems <br />�.: <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ I <br />m. <br />Kitchen sink 8 disposal <br />Gas fireplace <br />n <br />Dishwasher <br />� <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust tan <br />-.�.... <br />_ <br />�..�:.....��X <br />Back(low preventer <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 />Woadslove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity 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 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 Contractprs Law 18.27 RCW and 200.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />PERMIT <br />