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i f <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERAAIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425257-8857-www.evereHwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �.��L) -O� <br /> SITE ADDRESS PARCEL TAX I.D.R VERMIT 1{ <br /> / ��j �'t1E4L�t� 00 O b D� d70 � "Q�_ <br /> IEGAI LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRE55 �m�P P nornc 4ZS ;o3o }Z <br /> ?�ov►ald 1Mo�i� l(c/5 Cu( u. a�u z5zs �� <br /> TENRNTNAME I CONTACTFOR IT P�� <br /> Sliv�ne. Sci <br /> �C NTRACTOR ADDRESS CITYZP PFqNE <br /> "'R`�vn S� �� • 5 R �I �/U� I��L ��c�fiC 425.z2�- 5 503 <br /> U3E OF B LDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �CarG 9c'i I _Electric _Gas�Othei 1�0�� 3, 300 _ <br /> WORK DESCRIPTION <br /> -FoundQ�'ioh ��a�.v' garag� <br /> PLUMBING MECHANICAL <br /> NO. T'PE OF FIXTURE OR ITEM NO. TVPE OF FI%NRE OR I7EM <br /> Toilet A/C-air handGng un� <br /> BatFriub Forced air systems <br /> Lavatory(xash basin) _ Gas P�P��9 <br /> Shower Water heater <br /> ltitchen sink 8 disposal _ Cas fi2place <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> — ����,�Y _ Range hood <br /> Sink(servicelbar/mopletc.) _ Exhausttan <br /> Backilow preventer _ Heat pump <br /> Urinal Unil heater <br /> Dnnlurg Fourtlain Boiler <br /> Flaor drain Rehigeration <br /> Grease bap _ Woodstnve <br /> Roof drains Other <br /> Otlier <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereGy centify ihat 1 have read and examined ihis application and know ihe same to be true and correct All provisions ol laws and <br /> ordinaces goveming this type ol rrork vnll be complied with whether spedfied herein or not. The g2nting ot a permit does not prewma <br /> to grve authonty to violatr.or cancel the provisron of any other sFate or loral law reBulating consWction or ihe pertorman�x oi <br /> construction. That I am autFronzed by the ovmer of this property tn perfortn ihe work for which application is made and I comply with ihe <br /> State Contractors Law�8/�7 RC W and 296200 WAC. <br /> ��Q ��/'I ��� � "a'O'? <br /> Signa re oF rlContractor/Authonud Agerrt Date �� <br />