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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # I PERMIT # <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION p <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE' 49 <br />WI Illam6v�err 9 ma`s <br />TENANT NAME CONTACT FOR PERMIT PHONt <br />( <br />�(}W&AS Qj'1/AIe1Q- �- E•MaL <br />CIJTRACTOR ADDR SS ITYI P PHONE <br />CONTR. LICENSE J! <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Elect— rlc _Gas _Other <br />zZ 3/p. <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />N0. TYPE OF FIXTURE OR ITEM <br />N0. TYPE OF FIXTURE OR ITEM <br />Toilet <br />__ <br />A/C -air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />_Gas <br />range <br />_ <br />Clothes washer <br />Clothes dryer <br />Water heater <br />Range hood <br />:ink (service/bar/mop/etc.; <br />Exhaust fan <br />i <br />Backllow prevenler <br />Heat pump <br />— <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />—_ <br />Grease Imp <br />K <br />Woodstove <br />Roof drains <br />otner�s._� D�fE.�Sth*�OIdG, <br />Other <br />CITY OF EVERETT LOCAL SAES TAX CODE IS 3705 <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 />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />Signal e al OwnerlConlraclorlAulhorized Agent Date <br />