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r <br />P�r�MIT APPLICATICy�J <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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE AcD�DRESS <br />�� / �J / Qt�> ���� <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />TENANTNAME <br />CUNTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK QESCRIPTION <br />PARCEL TAX I.D. # <br />BLOCK TRACT <br />ADDRESS CITY/ZIP <br />CONTACT FOR PERMIT <br />ADDRESS CITY2IP <br />I — HEATSOURCE I <br />Electric Gas Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry iray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trxp <br />Roof drains <br />Other <br />PERMIT # <br />PHONE <br />PHONE <br />CONrRwcr PRict or wurcn <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan �L� <br />Heat pump <br />Unil healer <br />Bailer <br />Refrigeration <br />Woodsrove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br />I hereby cerihfy that I have read and examined lhis application and know the same to be true and correct. All provis��rns of laws and <br />ordinaces governing this type a`work will be complied with tivhether specified herein or not. The granting of a permit does not presume <br />to give authonry to violate or ca•icet the provision ot any other state or local law regulating construction or the performance of <br />construction. That I arn authorized by the owner of this property to perform the wnrk for which application is made and i comply with the <br />State Contractors Law 18.27,RCN' and 296.200 WAC. <br />A l, � � � <br />r_ . -.l � . ' � � .% �'cp`5 <br />