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PERMIT APPLICATION <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 />PM <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 <br />SITE ARDRESS <br />PARCEL TAX I.D. tl <br />PF.j2MIT N <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION p <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />TEN T NAME <br />CONTACT FOR PERMIT PHONE � <br />EMAIL <br />NT A S I / 1 <br />CONTR. LICENSE N <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_Electric /Gas _Other <br />/A�_ <br />WORKDESCRIPTION <br />�"��110Dc� �%i1��vA�/o LFvco�ii►'�'e�v f /oo,� <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 />Bathtub <br />_ <br />Forced air systems <br />_ <br />lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink &disposal <br />— <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow prevenler <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />_ <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 />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 Contractors w 18.2 R Wand 296.200 WAC. <br />O <br />Si atufe of wn tractorlAuthodze gent Date <br />