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� CITYPO EnVER ETPPERIMIT�SEROV+ICES �;f; J <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 PARCEL TAX I.D.p PER1.11T N <br /> C/�5//i'o SZ..p• c��'7'�C� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> OWNER ADDRESS CITY/21P PHONE <br /> TEN��� ��� CONTAn�F ERMIT PHONE <br /> ^�� �T �a� �f��W� <br /> t/(J� Lw��(�.� E•MAIL <br /> �a�a�ra'�i��m., g�s�k M s- u c�^..r c3q'—'' Q� sE <br /> CONTR.LICENSE M <br /> ►�Gor.�Sz*rDr��R fn �' �reck ,w�1 8v�2, <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> — �Dt� � <br /> Flectric _Gas_Other <br /> WORK DESCKIPTION <br /> � i � � �(�.t�.. -kd,. � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet AIC—eir handling units <br /> Bathtub Forced air syslems <br /> Lavetory(wash basin) _ Gas piping <br /> Shower _ Wate�heatar <br /> Kitchen sink d disposal __ Gas fireplace <br /> Dishwasher Gas renge <br /> Clothes washar Clothes dryer <br /> Water healer Range hood <br /> Sink(service/badmop/elc.) _ Exhaust lan <br /> Backllow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Foun�ain _ �oiler <br /> Floor drain Refrigeralion <br /> Grease�rep _ Woodslove <br /> Rool drains _ Other.—��— <br /> Other — � �� — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J106 <br /> I hereby ceAify Ihat I havo read and eznmined this applicalion and know the seme lo be tn�e and conect. All proviaions ol lews and <br /> ordinances governine�this lype ol work will be complied with whether specified herein or noL The granting ol a pertnit does not presume <br /> to give authority to vidate or cancel ihe provision ol any o�her slete or local law regulating conslruction or the perlormanca ot <br /> conslruclion. That I am authorized by the owner of Ihis propeAy to perform llie work lor which epplication ia made and I comply with lhe <br /> State Contractors aw 1827 RCW and 296200 WAC. <br /> ��1�— Ct- (,c,�--�,�-, 6� � 7-in <br /> SignaWre o wnedContractorlAuthorized�gent Date � / <br /> lZ <br />