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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.elierettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />RMIT # <br />C / ''U e- 5/4P <br />/O -01 <br />LEGAL LO N <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP <br />L <br />Ci/ /,PHONE 15hletl� `�'S�� V3�7 <br />TENANT NAME <br />CONTACT FOR'VERMIT PHONE <br />E-MAIL <br />CONTRACTOR ADDRESS IT IZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />Ct�`L-G /t _ Electric _ Gas _ Other <br />WORK DESCRIPTION <br />/ <br />LUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM - <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/map/etc.) <br />_ <br />Exhaust fan <br />_ <br />BackBow prevenler <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined !nis application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />tc give authority I"iolate or cancel the provision of any other state or local law regulating construction or the performance of <br />constructtpn: That t'am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Stat ontractors aw 1827-RAWZand6.200 WAC. <br />` Z/Q <br />Signae of Owner/Contractor/Aut razed Agent at6 e <br />