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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.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />bI�uPARCEL TAX I.D. # �DS-.� — 2C�� <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITY/21P PHONE <br />TENANT NAM I CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE p <br />USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric Gas Othe• <br />WORK DESCRIPTION / <br />NO. I TYPE OF FIXTURE OR ITEM <br />l oilot <br />Fathlub <br />I watery (wash basin) <br />_ Shower <br />_ Kitchen sink g disposal <br />_ Dishwash,.. <br />_ Clothes washor <br />_ Water healer <br />_ Sink (service/bar/mop/etc.) <br />_ Backflow preventer <br />_ Urinal <br />_ Drinking rounlain <br />_ Floor drain <br />_ Grease trap <br />_ Roof drains <br />Other <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />n/c — air naneiing units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryor <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions 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 slate 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 co nply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />