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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 />SITE ADDRESS <br />PARCEL TAX I.D. # PERMIT # <br />LEGALULOT NO. <br />BLOCK <br />— <br />TRACTOR SUBDIVISION <br />DESC. <br />OWNER <br />ADDRESS CfTy1ZI1P PHONE <br />Iq <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />E-MAILCONTRACTOR <br />CONTR. LICENSE # <br />ADDRESS ____C1TTM PHONE <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE <br />OF WORK <br />Fiectric _ —Gas —Other <br />— <br />WORK DESCRIPTION <br />— <br />r / <br />, •�1-�- ��i111.'C.f T-T. e/r'i� ,T7'/Y''-�. <br />t <br />PLUMBING 1 MECHANICAL <br />NO. I (YPE OF FIXTURE OR ITEM <br />_ Toilet <br />_ Bathtub <br />_ Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink 8 disposal <br />_ Dishwasher <br />Clothes washer <br />_ Water healer <br />_ Sink (service/bar/moplatc.) <br />_ BackBow preventer <br />_ Urinal <br />_ Drinking Fountain <br />_ Floor drain <br />_ Graeae trap <br />_ Roof drains <br />Other. <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ A/C — air handling units <br />_Forced air systems <br />_ Gas piping <br />_ Water heater <br />_ Gas fireplace <br />_Gas range <br />_ Clothes dryer <br />_Range hood <br />_ Exhaust fan <br />_ Heal pump <br />_ Unit heater <br />_ Boller <br />_ Refrigeration <br />_ Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX C.)DE IS 3108 <br />I hereby carilify 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 prevision of any other stale or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of ;his property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCWend 296.200 WAC. <br />Signa!ure a Owner/ConlractorlAuthorized Agent et)—� <br />l� <br />