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02/14/2013 21 : 57 �1924 P. 001/002 <br /> i <br /> I-ERMI�A,�.?PL�C�ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, E�/ERETf, WA 98201 <br /> 425-257-@810- FA�(425-257-8857-wwvd,everettwa.org <br /> I . APPLICATIONS ARE ACCEPTED FROIYIB APd TO 4 PM. a -I r'1 "'I 3 <br /> SIT�ApORESS pq�CEL TAX I,p,il PeRMIT# <br /> Z.23/ ,�<.�Pw� '� ?�C � - � ' �. <br /> LEG LOiNO. BLOCK TRACTORSUBpIWSIONIY <br /> DLSC. <br /> OWN[R � AOURESS CITY2IP NON � <br /> -�54�-.u�w �n tr .Z 2 3 / B� y ., ,C-'?r3�' 9.PZ0 r' G/Z��LSZ-✓'"�� <br /> TENANT NAME • I CO�t aC7�FOR PERMIT aHON6 <br /> CO ACTOR .. .. . . . •E-MAIL I <br /> E�y.�v���.-- .5.�/�.I� ✓`�.� 3C�/ .�v� , rrxi �PHo I <br /> CONTR.LICENSE k ��`� �` """' ���� L/2,7^Zs"9—zICI I <br /> L�f'� �f�V ss o yz K2 � <br /> USC OF BUILDING F1EAT SOl1RCE I CON7FtACT PRICE OF WORK i <br /> (/'p/rj� t�itiiF� I ,ElecVic'�Gas.,_other ��� 7 �- I <br /> WORK q�SCRIPTION � � ✓ . <br /> f�r �4� �ag`�,7�a�o �N� �;;�-„ , <br /> . ✓ - .2 �Y1 "'l � ��) 1 I <br /> �FDO#s � <br /> �— PLUMBING MECHANICAL I <br /> NO. 7YPE OF FI%TURG OR ITEM NO. . . TYpE OF FIXTURE OR ITEM I <br /> Toile� A/C—air handling units <br /> � Bathtub � Forced air systoms <br /> _ Lavatory(wash basin) � Gas piping <br /> _ Shower , Water heater <br /> Kitchen sink&disposa� Gas fireplace <br /> _ Dishwasher � Gasrange ' <br /> _ Clothes washar , _ Clothes dryer � <br /> � Walerheater Range hood <br /> _ Sink(service/6admopletc.) , _ Exhausl fan <br /> BackOow preventer i, Neat pump <br /> ! ur�nal _ Unit heater <br /> � Drinkinp Fountain � Boilor <br /> � Floordrain � Refrigoradon <br /> Greaso vap _ Woodsfove <br /> � Roof drains Other <br /> " Other <br /> qTY OF EVERETT 40CAL SALGS TAX CODE IS 3105 <br /> I hereby cerilify that I have read and e�mined this applieatloq and know tho same to be Iruo and correcL All provisions of laws and <br /> ordinacos govoming Ihis typo of work will bo complied wilh whether speciTiod harein or not.The granting of a pormit does not presume <br /> lo givu authority to violete o;cancol the provision of any other slate or local taw repulating constructlon or the performance of <br /> � construction.7hat I am authorized Dy the awner of this property lo pedorm U7e work for which appliea4on is made and I compty with the <br /> ( Slalo qontractors Law 18.27 RCW and 296.20D WAC. <br /> �U���� .2--/.r�3 <br /> Signaturo of wner/ ontractor/Authonzed Apent �alo <br /> � , I <br /> `/� <br />