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FeE. 9. 2011 10:26AM <br />SITE AD�RESS <br />L07 N0. <br />�N <br />NAME <br />PERMIT APPLICATION <br />CITY O� EVERETT PERMIT S�RVICES <br />320C CEDAR STREET, EVERETT, WA 98201 <br />425-257-a310 - FAX 425-257-8857 — www.everettwa,org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. t <br />� 2 �\ � c�o'-+cc <br />BLOCK TflACTORSUBDIl�ISIONB <br />AODIiESS <br />W�� �ct�—�— <br />CONTACT FOR PEq IT <br />Shanna, oc��r� <br />A�(w I nC ADSI£or� � St �Jv` <br />CONTR. UCENSE M GM �ie.P,C� toSS'6L <br />USE OF BUILOING <br />HEATSOURCE <br />_Electric _Cias �her <br />No.6466 P. 2 <br />a-i7-/l <br />PERMIT k <br />� �Yll I t7z� �°�I'� <br />121P PHONE <br />�in � 8 (ac���5 <br />PHONE a �� <br />E•MaL, S?-+0.1Y�bi'.�2mP� <br />�l I%"�1 �53 8l� S1c � �� <br />q� <br />ICONTRACT PRICE OF WORK <br />_ .. . _ � <br />WORK DESCRIPTION �� � �,�L , y,�`,� . � u ��� <br />����R�, CJ�`.v� (.J�� � � � -' �XJ �-��Y'$ �'I� <br />�;v..ata99 �►-t�» 2ec,�troon-, .n� ��"-��"A' � QSSoc.• lA�.cC.� . <br />N0. I TYPE OF FIXTURE OR iTEM <br />Bathwb <br />Lavatory (wash basin) <br />Shower <br />K'itchen sink 8 dlsposal <br />Dishwashef <br />Ciothes wa5her <br />Water heator <br />Slnk (service/bar/mop/etc.) <br />Backftow preventer <br />Urinal <br />Drinking Fountaln <br />Ploor drain <br />Grease trap <br />Roof dralns <br />Other <br />NO. I TYPE OF Fl7(TURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />ClOthes dryer <br />Hango hood <br />E�aust lan <br />Heat pump <br />Unit heater <br />Boller <br />Refrigeration <br />Woodstove <br />Other—�� �Si��i <br />CITY OF EVERETT LOCAL SALES TAJf COL1E 13 3106 <br />I hereby cerifity ihat I have read and examined this application and know ihe same to be true and covect. All provisions of laws and <br />ordinaces governing this type of work wlll he complied with whether specitied horein or not. The granting of a parmit does not presume <br />to give aulhoriry to violata or cancel ihe provision of any other stata or Iocai law regulating construc6on or Ihe pedormance oi <br />conslru�ion. That I am authorized by the owner of lhis property to peAorm Ihe work lor which appllcation is made and I comply with the <br />State ntraclors Law 1827 RCW and 286.200 WAC. , <br />