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SRE ADDRESS <br />PERMIT APPLIC�TIOIV <br />CITY OF EVEREI7 PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8870 — FAX 425-257-8857 —www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. p <br />LOTNO. I BLOCK � TRACTORSUBDIVISIONiC <br />lD —�i -ti'� <br />PERMR # <br />C�7/(1— <br />��S�.r i � <br />�I OWNER ADDRESS CfTYlL9 PMONE <br />v25 e'�9�53k5`- C <br />i����p � }Jp�cCx �C� l�ntmnc�aCcy (�C�nCI�'Ilp C.J� �I7S-37]�Stis= <br />TENAKTNAME CONTACTFORPERMIT � PHONE <br />IE-61AIL <br />�� D <br />CONTR. LICENSE p <br />.�/.� iLl�� <br />USE OF BUILDING <br />I WO <br />HEATSOURCE <br />_ Electric ,_ Gas _ Other <br />�� ;,1.,( �� .;��.-t,v-�. �� j ��.v ,� t� <br />N0. I 'R'PE Of FlXNRE OR ITEAf <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Showe� <br />Kitchen sink 8 disposal <br />Dishwusher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking fountain <br />Floordrain <br />Grease trap <br />Roof drains <br />O�her <br />CONTRACT PRICE OF WORK <br />ryp, I TYPE OF FlXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas lireplace <br />Gas �anc,�e <br />Clo�hes dryer <br />Rarge hood <br />� Erhaustlan <br />_ Heat pump <br />Uni� heater <br />Boiler <br />Re�rige2lion <br />Woodstove <br />Olher <br />CITY pF EVERETr LOCAL SALES TIU( CODE IS 3105 <br />I hereby ceritily ihat 1 have reatl and examined lhis application and know the same to be irue and correct. All provisions ol laws antl <br />ordinaces governing this type of work will be complied with whether specilied herein or nol. The granting of a permit does not presume <br />Io give aulhonty lo viWate or cancel Ihe provision ol any other state a local law regulatir� construction or the periormance ol <br />conslruction. That I am authorized by the owner ol this propehy to pedorm the work lor which application is made and I comply with ihe <br />State Conlractors Law 18.27 RCW and 296200 WAC. �y <br />�/.�..���.w�/ IV"' I-O/ <br />