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, <br /> � cRMIT APPLICATI(�N <br /> C9TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEFETT, WA 98201 <br /> d25-257-8810— FAX 425-257•8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRES5 PARCEL TAX I.D.# PERMIT# <br /> i OCj � `i'7, c�a � .�— <br /> LEGAL� LOT NO. BIOC TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER AD�RESS CINIZIP PHONE r <br /> l -L��/t•�' r - �' ��4� E;����r'�c��� C�P.�f-������ �sa-��� <br /> ENANT NAME CONTACT FOR PER PHONE <br /> '�� ✓��� !7S �v� E-MAIL <br /> CONTRA TOR A DRE CIT IZI P O E <br /> ?�,������I�TY M���n-c,V�c� �itos ��5 ��t4 A"Yl/�-l�iz�,v qbzzj y25 �73�-97� <br /> CONTR.LICENSE# . cJT f�� <br /> P�.�p�.h1P °�L`L.T�j �,�/�l <br /> USE OF BUILDING HEAT SOURCE ���i� CONTRACT PRICE OF WORK <br /> �Eleclric _Gas_Other '^ZQQL1,�� ' <br /> WORK DESCRIPTION <br /> �7'170L1 T7U�`' O�' Cf���� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet fJO /�/E — A/C–air handling uni�s y� � <br /> Balhtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal � � Gas fireplace <br /> Dishwasher . Gas range <br /> Clothes washer . CloBies dryer <br /> Water healer . Range hood <br /> Sink (service/bar/mop/etc.) Exhaust fan <br /> Backfiow preventer Heal pump <br /> Unnal � Unit heater <br /> Diinking Founlain Roiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drains � Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> 1 hereby certify Ihat I have read and exa�nined this application and know the same to be Irue and correct. All provisions of laws and <br /> ordinances goveming this type ol work��ill be complied with whether specified herein or noL The granting ot a permit does not presume <br /> to give authorily lo violate or cancet Qi=provision of any other state or local law regulating construction or the perTormance of <br /> constructioa Thal �am ai�lhorized by A�e o�vner of�his property to peAorm�he work for which application is made and I comply with the <br /> $ta e ConUaclors Law 18. CW and 29G200 WAC. <br /> � �n� �ry-i[��i��r ���7�0 <br /> ignaWre of OwnedContractodAuthor¢ed Agent Date <br />