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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.everetiwa.org <br /> �� APPUCATION5 ARE ACCEPTED FROId 8 AM TO 4 PM s—S-0� <br /> SITE ADDRESS PARCEL TAX I.D.l7 PERMIT# <br /> ���� �c � � _ a�e . - � .r ��o �i �13���► �ic� �, {-�ti��s ���� <br /> L[GAL LOT NO. BLOCK TRACT OR SUBDIVISION p � <br /> DESC. <br /> OWNER ADDFESS CITViZIP PMONE <br /> �C, ,�� PiR�iie�� IPree�ur ,���v� i��.clCer�lve . F�c.rett `l���l d0� . �`�c,, . 15'`il <br /> TENANTN� CONTACTFORPERMIT PHONE <br /> E-MAIL <br /> 1 <br /> t-IC�1 O C C1�3���uC1� v�'l 4�`.���5� 3�`.i� <br /> CONTR.LICENSE A <br /> FICILC'CCI�155 Gl7 Il�l � 11�Qrine 1hr�� Dr. S�t �3 EJereti <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I �^ ,�,� _ 1 ` _Electric Gas ___ Other 1 �C C C�o <br /> WORK ESCRIPTION <br /> I ��e`'xt�r W(l11 ��Oir��1�rJ . `���1 ��1c` � j�r�,��A11 , iYlSl,�ll'1�� C1�� �M OC'CK���C1 <br /> 7c��v�c;c�r��� t3� � C",re . � J <br /> ` PLU BING MECHANICAL <br /> I NO. TYPE OF FIXTURE OR f�EM NO. TYPE OF FIXTURE OR ITEM <br /> IToilet A'C–air handling uniis I <br /> Bathtub Forced au systems <br /> Lavabry(wash basin) __ Gas piping <br /> Shower _ Water heater <br /> I � Kitchen sink&di,posal Gas lireplace <br /> '�, _ Dishwasher Gas ranye <br /> '� Clolhes washer _ Clolhes dryrr <br /> Water heater Range hood <br /> �� __ Slnk(service bar.mop etcJ Exhaust fan I� <br /> I Backtlow preven�er Hea�pump <br /> i _ _ Urinal Unit heater <br /> ��� _._ Drinking Foun�ain iloiler <br /> . Floor drain Reirigeration <br /> � Grease Irap Woodstove <br /> Rool drains Other <br /> � Other - --- — — – . — <br /> � CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> , I hereby ceritify�hat I have read and examined Ihis application and know the same lo be true and wrrecL All provisions of laws and <br /> , ordinaces governing Ihis type ol work will be complied with whether specilied herein or noL The granling ol a permit does not presume <br /> 'I to give auihoriry to viotate or cancel the provision of any olher state or local law regulaling construdion or Ihe pedormance of <br /> '�� construclion. Thai I am aulhorized by ihe o�vner of ihi,property lo per(orm the work lor which application is made and I comply wi�h the <br /> � Slale Iractors La v 18.27 RCW and 296200 WAC. <br /> ����r� O '�i,��! i ����G/ C�� <br /> � S�j aWre ol wneuConhacloriAuthorized Agent � �Date <br />