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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 I PARCEL TAX I.D. # ,PERMtT # T <br />LEGA LOT N <br />DESC. O. BLO TRACT OR SUBDIVISION # <br />OWNER ADDRESS L �CITY/ZIP PHON <br />TENANT NAME I CONTACT FOR PERMIT PHOW34,o ZI * c�-.S i!S i <br />CONTRACT2 E-MAIL 2 n I-6�n5cx1 G <br />F_a_"�\ k%� 1�Y�� �c;�1S`�Cl 6Y11 j I(lG Icw C.�ti <br />CONTR. LICENSE # -se-, L4 maw ns\7 I I Le- r !/� A C-t <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric _rGGas _ Other <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backfiow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />0_+qbn - S <br />NO. <br />A/-/P'0 / L -S / � _ <br />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 />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 />