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( <br /> P�RMIT 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 PARCEL TAX I.D.# PERMIT# <br /> I101 � ��' �. <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENAyT NAME � , CONTAC7 FOR PERMIT PHONE <br /> / <br /> / <br /> CONTRACT ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas Olher <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR i iEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> '%'i Kitchen sink&dispo�al Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Cbthes dryer <br /> Waler heater Range hood <br /> � Sink(service/bar/mop/etc.; Exhaustfan <br /> BackFlow prevenler Heatpump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> � Floordrain _ Refrige2tion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> I hereby ceritify that I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces governing lhis lype of work will be complied with whelher specified herein or not.The granling of a permit does not presume <br /> to give authorily to violate or cancel the provision of any other state or local law regulaUng construclion or the performance of <br /> construction.That I am aul orized by the owner of this property to porform fhe work for which application fs made and I comply with the <br /> State Contractors Law 1 7 RCW a 296.200 WAC. <br /> � <br /> Sig ure of Owner/Contractor Authorized Agent Date <br />