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; <br /> J, �i � - i� �Nuvr�il�vr. ��� �s � �� <br /> P�R�IiiT APPLICA o"IOP! � <br /> CITY Qf E�fERETT PERIVIIT SERViCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICA710NS ARE ACCEPTED FRO!N 8 AM TO 4 FM �D6�� <br /> SITE ADDRESS PARCEL TAX I.�.# pERN�Il p <br /> 0 0� �// J�- �: -. �' �c��- �� <br /> LEGA LOT H0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. �l, - �L .007 � � � ' �-.�, <br /> OWNEti AOORE55 C(lY PHONE <br /> �inv �vr �n1U�7rnGi�1i5 ��FlC �P� 73c,x i3o�-J , 11�A�z��SViLC.G (,�t� I�S�-70 <br /> TENAtR WAME CONTACT FOR PEHMR PHONE <br /> � S.�EA�YY-� �ES��'U�Ez e-Ma��/fikr.l�ai�l;r�U�2 k4:,Cd � <br /> EWWC)I� C1uUN1n\I CCl�ISTI2L(CIiCUr�� I/�j(�• <br /> CONTR.LICENSE p ' / <br /> c-ar�=11 y�l�l�� 1�i) ,t3dX ,'3U�-1 — `�IAR� i/i[j � `� <br /> USE OF BUILDING HEAT SOUHCE CONTRACT PRICE OF WORK <br /> 5 ��J . __F.!ectric �Gas_Other <br /> WORK DESCRIPTION _ S�=�;,Z <br /> nl�I,� Cu��.Sir��G�l�VI ���(L�2.2 <br /> ��a�o � - �-,� � C 3c=-G �� i , - <br /> PLUM ING �AECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEG7 NO. TYPE OF FlXNHE OR ITEM <br /> 3 Toilet A/C-air handling units <br /> � Bathtub Forced air systems <br /> � Lavatory(wash basin) � Gas piping <br /> Shower 1 Water heater <br /> 1 Kitchen sink 8 disposal Gas tireplace <br /> � Dishwasher Gas range <br /> I Clothes washer � Clothes dryer <br /> � 'Nater heater � Range hood <br /> Sink(service/bar/mop/etc.) � Exhaust fan <br /> _I Backflow preaenter _ Heat pump <br /> _ Urinal I�nit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeratior <br /> Grease trap Woodstove <br /> J Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA7C CODE IS 3705 <br /> I hereby cerilify ttat I have read and examined this application and know ihe same ro be true and c:orrect. All provisions of laws antl <br /> ordinaces goverc�rg!his type o(r+ork will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority t�violate or cancel ihe p;ovision of any other state or local law regulating construction or�he performance of <br /> construction. That I am authorized by the owner of this property to perform�he work for which application is made and I comply with ihe <br /> State Contracrors Law 18.27 RCW and 296.200 VJAC. <br />► <br /> SignaNre ot Ov:ner/Con!racror/Authorized AGent Date <br /> i ��Z <br /> -R,t <br /> --- - ---�- - <br /> �'�,``� �°'_', <br />