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PtRMIT APPLICATIuN <br />EVERETT PERMIT SERVICES <br />3200 CEDAR STRtET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />PARCEL TAX I.D. # <br />2Io��4aa� /as� <br />YdJ-v77�"'J`/ I <br />(l�as �ti�,. l.�s� ��.�. i�� �� �(�x �Z�7 � dv1;11 C''c-c�k �tB�sZ. <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />Toilet <br />Ba�htub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Cbthes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />/ Yias _ Other <br />A/G — air handling unils <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas (ireplace <br />Gasrange <br />Clolhes dryer <br />Ranc�e hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />I hereby cerili(y thal I have read and examined this application and know lhe same to be lrue and correct. All provisions ot laws and <br />ordinaces governiny this type o( work will be complied with whelher speciiied herein or not. The granting of a permit does not presumE <br />to give aulhority lo violale or cancel the provision of any olher stale or local law regulating construction or the performance of <br />construction. Thal I am aulhorized by lhe owner of this property lo perform lhe work for which applicalion is made and I comply wilh the <br />Stale Conlractors Law 18.27 RCW and 296.200 WAC. <br />Signalure o( OwnedContractor/Aulhorized Agent Date <br />