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APPLICATI <br />EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />�EARTL A� Si c�PA4E S>/6L S I <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Cbthes washer <br />Laundry tray <br />Sink (service/barlmop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Founlain <br />Fioor drain <br />Grease trap <br />Roof drains <br />Other <br />� Electric _ Gas <br />�U«.���.lG. <br />wt; — air nanoung unus <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfen <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />I hereby ceri6fy that I have read and examined lhis application and know the same to be true and correct. All provisfons of lewa and <br />ordinaces governing this type of woric will be complied with whether specified herein or not. The grentlng of a pertnit does not presume <br />to give authority to violate or cancei the provision of any other state or local law regulaGng constructlon or the perfortnance of <br />construction. That I am authorized by the owner oi this property to perfortn the work for which application is made and I comply with the <br />$i2te Contractors Law 18.27�RCW and 296.200 WAC. <br />