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Ik-RMIT APPLICATAN <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 />1 ? <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ll�t/ <br />SITE A DRESS <br />PARCEL TAX I.D. N <br />P RMIT N <br />o• s� Zti <br />/o <br />LEGA LOT NO. BLOCK <br />TRACTOR SUBDIVISION N <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />�lasazpS= o�y� <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />_ <br />E-MAILCONTRACTOR <br />ADDRESS CITY/ZIP <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE CONTRACT P E OF WORK <br />Electric _ Gas Other <br />WORK DESCRIPTION <br />ram-( `d✓r <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 />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodslove <br />Root drains <br />Other_ <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisicns of laws and <br />ordirlac^s 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 owaer of this property to perform the work for which application is made and I comply with the <br />'Pate Contractors Law 18.27 RC V and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date ), <br />