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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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <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 />\17'/Qy C& 11 S1 , F, '.f#, .9 qx : <br />TENANT NAME <br />CONTACT FOR PERMIT — PHONE <br />�/ j- <br />�sy G'% � %�'Pylf.� <br />_ <br />CONTRACTOR ADDRESS ,.— CITY/ZIP — PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK \ <br />_ Electric ✓Gas _ Other <br />WORK DESCRIPTION 13;4s16 <br />BAC� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM - <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C— air handling,uriits' <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater", <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range / <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />.3' <br />Range hood <br />Exhaust fan <br />Backflow preventer <br />Urinal <br />Heat pump <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 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 authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />r <br />