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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 �� � a��� <br />CONTRACTOR ADDRE55 CITVIZIP PHONE <br />`1i�%/�'�'���"!%3i� <br />USE OF <br />WORK OESCRIPTION <br />NO. I TYPE OF FIXTURE OR I�EM <br />�� Toilel <br />Balhtub <br />Lava�ory (wash basin) <br />Shower <br />� Kitchen sink 8 disposal <br />� Dishwasher <br />� Clothes washer <br />Laundry tray <br />Sink (servicelbarlmop/etc.) <br />� Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEATSOURCE <br />�Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />A/C — air hantlling unils <br />Forced air sys�ems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exliaust fan <br />Heat pump <br />Uni� heater <br />Boiler <br />Refrigeretion <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TA%CO�E IS ]705 <br />I hereby ceritify that � have read and examined ihis applicalion and know the same to be true and correcl All pwvisions of laws and <br />ordinaces goveming ihis type of work will be complied wi�h whelher specifed herein or not. The grenling of a pertnil does nol presume <br />to give authari to violate or cancel the provision ot any olher stale or local law regulating construction or the peAormance of <br />construch Th it I am authorized by the owner of this property to peAorm the work (or which application is made and I comply with the <br />Slate C �t aclprs �; 18 RCW a�n '296200 WAC. � <br />Il��-r//�/,'�'///r' l �> / <br />