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PE,ZMIT APPLICA�'IC-f <br />�y^ CITY OF EVE':ETT F'ERMIi' ��ERVICES <br />�� 3. 00 CEUAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 4�5-257-885 �— www.evereltwa.org <br />.L-cfs �-; �`' <br />ApPLICATIONS ARE ACCEPTED FP.OM 8 AM TO 4 NM - DE81T & CRtDIT CARDS ARE NOT ACGEPTED <br />I FARCEL TAX I.D. R I PE��� r-D r.�'�- <br />SITE ADDRESS A _ _ _ _ �� i <br />LOT NO. <br />DESC. <br />TENANTNAMF <br />� CONTRACTOR � <br />�I R�,byrn T. N t,LL <br />I CONTR. LICENSE # <br />r � G•S 3.: <br />USE OF Bl LDING <br />WORI< DESCR�R�FT�ON <br />ELOCK I TRACT <br />ADDRE55 <br />.� � Lt�C� <br />I CONTACT FOR PERMIT <br />_ ��Q �� <br />ADDRESS <br />—qL�, N��siNEs�,;�� i�r � <br />- I — HEATSOURCE <br />Elec[ric � Gas _ Olher <br />.� _ . —r� 1 _ �� <br />N0. I TYPE CF FIXTURE OR ITEM <br />Toilal X2 � �p <br />Bathtub K 2 = 2- <br />Lavatory (wash basin) x2 0 <br />Showerk Z .-2 <br />Kitchen sink 8 disposal r Z �Z <br />Dishwasher ti 2 = �- <br />Clothes washer x 2= 2 <br />Laundry lray <br />Sink (service/barlmopletc.) <br />Back9ow preventer y �; � <br />Urinal <br />Drinking Fountain <br />Floar drain <br />Grease lrap <br />Roof drains <br />0!her <br />rr+oNe <br />� <br />C�7y2�p PHONE <br />; i 5� ��`t <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A1C - air handlir�g units _ Z <br />Furced air systems X 2 <br />Gas piping X2 = �p <br />Waler healer x 2 :Z <br />Gasfireplace k z cZ <br />Gas renge <br />Clothes dryer X 2 � <br />Range hood X �' L <br />Exhauslfan k 2 = � <br />Heatpump <br />Unit healer <br />Boller <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceritify lhat 1 have read and examined this applica6on and know the same to be truo and correct. Ail provislons ot laws and <br />ordinaces goveming lhis lype of work vnll be complied wilh whelher specified herein or nol. The granling of a pertnil does nol presume <br />to give authonry ro violate or cancel lhe provision of any olher stale or local law rec�ulalinc� consWction or the performanco of <br />constniction. That I am authorized by lhe owner of lhis properly lo perform lhe work for which application is made and I comply wifh lhe <br />Slate Contracto�w ��yR�W and 296200 WAC. � � _ <br />� <br />'IL <br />« <br />