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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.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />TENANT NA CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />/1 <br />CONTR. LICENSE k <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_ Electric _Gas _ Other <br />O <br />WORK DESCRIPTION <br />/}p0 �orvt�i�� 55oR 12oQ►v� ouT£'1 Ali' OF a��G � <br />(so to/ o-o13� o <br />_ <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />_ <br />Shower <br />Water boater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_Clothes <br />dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Back9ow preventor <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Floor drain <br />_Boiler <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />Weodslove <br />_ <br />_ <br />Roof drains <br />_Other <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby corllify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing This type of work will be complied with whether specified herein or n0t. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any ocher stale or local law regulating co. ,.�:;„c8en or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which appllca8nn is made and I comply with the <br />St to Con tors LJ18.2 RCW and 298.200 WAC. <br />igna e Of OwnorlCo actorlAulhorized Agent D c �'.M <br />