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ERMIT APPLICATIiUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />ADDRESS <br />TENANT NAME <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />YL'GniC DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BAT4TUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PARCEL TAX I.D. # <br />CONTACT FOR PERMIT <br />AODRE55 <br />Building Mechanical <br />PERMIT R Combination � Plumbing <br />TYPE D Demolilian Sign <br />U Sprinkler <br />PERMIT # <br />Pa3�o- <br />ZIP PHONE <br />ZIP <br />PHONE <br />CONTR. LICENSE P <br />j"� Addilion <br />y� Alleretion <br />I�' New <br />l.J RepaidMaint. <br />HEATSOURCE <br />Electric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I T1'PE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACEiSTOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I NEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AN� CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />C�ONT R OF HS ��RGR �hAND 2 6 2 Ryy CORK�FOR WHICH AP � A AC� NFS MADE ANOD I�COMP Y W TH T�HTEHSOA ZEED BY O EHER <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />