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PERMIT APPLICATION <br />CITY <br />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. # <br />RMIT # <br />AA <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER <br />ADDRESS CITY/ IP PHONE <br />�7NN{{�0 <br />TENANT NAME <br />CONTACT FOR PERMI PHOhE <br />CONTRACTOR <br />ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />�404'�'e <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric as Other <br />WORK E CRIPTION <br />----__ , <br />235 <br />PLUM <br />ING <br />MECHANICAL <br />NO. TYPE OF FIXTURE TEM'----- -`--- <br />NO. TYPE OF FIXTURE OR ITEM <br />CP <br />Toilet / <br />A/C - air handling units <br />Bathtub/ / <br />Forced air systems <br />(p <br />Lavatory (wash basin) I / / <br />Gas piping - <br />Shower <br />_, <br />Water heater <br />Z <br />Kitchen sink & disposal <br />z <br />Gas fireplace / <br />Dishwasher <br />Gas range <br />z <br />Clothes washer <br />7- <br />Clothes dryer <br />Z <br />Water heater <br />z <br />Range hood <br />Sink(service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that I have read and <br />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 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 auth razed <br />by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.2 1W <br />and 296.200 WAC. <br />Signature of Owner/Contr t thorized Agent ate <br />