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P�RMIT 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 /> APPLICATION3 ARE ACCEPTED FROM 9 AM TO 4 PM <br /> 81TE ADDRESS PARCEL TAX I.D.N P MIT N —�� <br /> INv'l 3a1<�tL. ve- cs,Pc - aqos- �� o -u3o � o� 00 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. I <br /> OWNER ADDRESS CITY2IP PMONE <br /> l�-�c�.�(L�r1l�-QR.�s«���1.� l-lu'�a-3�(aueSL �'ltell�qSota� �la�-"1�13-IlIS <br /> TEHANTNAME CONTACTFORPERMIT PHONE <br /> .• i �.ya �es��� ►�s --,�a: «l�:� <br /> CONTRACTOR ADDRESS CITY2IP PH6NE <br /> a ciici.tz- ErL�-ti�lsrS���- 1'10��.-3�(�v�SE :��v.119801�- N�.ti �3 <br /> CONTR.LICENSE M � ; • ( � (� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE Of WORK <br /> 5�f���'r- �0�1����� ��-�`y�� _Eleclrlc �t`as_Other <br /> WORK DESCRIPTION <br /> I-} e- w C w..9LN,.��-wr c� �L :i�..,�.� �,., .JuA�-cSL4.v..+' <br /> g��- � sq <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FU(?URE OR ITEM <br /> � Toilet A/C—airhandlingunits <br /> BaUdub = Forced alr systems <br /> � Lavalory(wash basln) � Gas pipin� <br /> Shower Waler healer <br /> Kitchon sink 8 dispnsal � Gas fireplace <br /> � Dishwasher � Gas range <br /> Clolhas washor _L Clothes dryer <br /> Wator heater �_ Rango hood rn�aZ <br /> _ Sink(sorvicelbar/mop/etc.) � Exhaustfan <br /> BackOow preventer _ Heal pump <br /> Urinal Unit healer <br /> Drinking Faunlaln _ Boiler <br /> Floor draln Retrigerallon <br /> Groaso lrep _ Woodslove <br /> Root drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA7(CODE 19 7105 <br /> I horeby ceritify thal I have read and e camined thls a�plication and know the same lo be true and cortect. All provlsiona of laws end <br /> ordinaces governing Ihis lype of work will be complied with whether specified herein or not.The granling of e permit does not presume <br /> lo gi�,a aulhorily to violate or cancel the provislon of any other slale or local law regulaUng construc0on or lhe perturmance of <br /> construction.Thal I am aulhorized by Ihe owner oi lhis property to perlarm lhe worlc for which epplicaUon is made and I comply with the <br /> Sta�Contractors Law 18.27 RCW and 296.200 WAC. <br /> �+' <br /> Signalure f ner/Conlraclor/ h ized Agenl a a <br /> 1 <br />