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1-ERMIT APPLICAT�uN <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 ��j�/Z –OZ��l <br /> SITE A�RESS �� PARCEL TAX I.D.# P M' D��/J <br /> � � <br /> LEGAL LOT N0. ELOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � �� J E-MAIL <br /> O RAC O ADDRES ITYI P H NE <br /> CUNTR.LICENSE# <br /> USE OF BUILDING HEAT SqURCE CONTRACT PRICE OF WORK <br /> Eleclric (� Gas Olher <br /> WORK DESCRIPTION 1 - <br /> ���� ��L�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) � Gas piping <br /> Shower _ Water heater <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/barhnop/elc.) _ Exhaust fan <br /> BackFlow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain � Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Rooi drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined lhis applicalion and know the same to be lrue and correcL FJI provisions of laws and <br /> ordinaces governing this rype o(work will be complied with whether specified herein or not The granting of a permit does not presume j <br /> to give authority to violale or cancel ihe provision of any other state or local law regulating construction or the peAormance of <br /> conslruction.Thal I am aulhorized by lhe owner of this properly to peAorm the work for which applicalion is made and I comply with the <br /> Slatq�o raclors Law 18.27 Ri:W and 296.200 WAC. <br /> ,r�. � ,�- =— g ) �3 �cg <br /> 5ignaWre o(OwnedCoNreclor/Authorized Agenl Date <br /> �. <br />