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PERMIT APPLICATOW <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 S AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />P IT N <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER �. ADDRESS CITY2IP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR LL C ADDRESS PHONE <br />goy- <br />CONTR. LICENSE N ►�I�»�65(�'��(f't-( s<.. 4+ lcc:-;�ItgluV <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />S�+ �� , <br />X-ElocMc Gas Other <br />I <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />3 <br />Toilet <br />_ <br />A/C - air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Shower <br />= <br />Gas piping <br />Water heater <br />,j <br />� <br />Kitchen sink 8 disposal <br />_Gas <br />fireplace <br />Dishwasher <br />Clothes washer <br />_Gas <br />range <br />Clothes dryer <br />� <br />Laundry tray <br />_Range <br />hood <br />_ <br />Sink (servlcelbarlmop/etc.) <br />Exhaust fan <br />_ <br />BackOow prevenler <br />_Heat <br />pump <br />_ <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />_Boller <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />� <br />Other �-c.!' �i <br />_Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerltlty that I have road and examined this application and know the same to be true and correct. All previsions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction That I am authorized by the owner of this property to perform the work for which application Is made and I comply with the <br />Slate Contra aw 18.27 RCW and 296.200 WAC. <br />Signature o caner ontractor Aut orize gent ate <br />