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PERMIT APPLICATKA <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 A DRES <br />PARCEL TAX I.D. # <br />PERMIT N <br />p o r Zt-- <br />1 Q <br />LEGAL LOT NO. BLOCK <br />TRACTOR SUBDIVISION p <br />DES(:. <br />OWNER ADDRESS CITYIZIP DRONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />E-MAIL <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />/ �� <br />CONTR. LICENSE k WA�K—� � <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT P E OF WORK <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 />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/olc,) <br />_ <br />Exhaust. fan <br />Backflaw preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodslove <br />_ <br />Roof drains <br />Other_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 />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 />le,Conlraclors Law 16.27 RCW and 296.200 WAC. <br />SI9nJature of Owner/Contractor/Authorized Agent Dale <br />