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C C <br /> . � PERMIT ARPLICATION I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT. WA 982�1 <br /> 4:!5-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATlONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE A�DRESS PARCEL TAX I.D.# P �T� <br /> 33S lac-�t�ER �,Ec� lJ� `1Bto3 5849 � oo'� oo t o009 � �d - 3 <br /> LEGA LOTNO. BLOCK TRACT - <br /> OESC. <br /> OWNER AUDRESS �yE ��Lt CITYRIP PHONE <br /> �ie�w� ot+-. 9zs-ggo- 9999 <br /> � .. R„�� �r�.-� �� I��� ��,� 2�3 t��.�E���. � <br /> 7ENAN7NAME CONTACTFORPERMR PHONE <br /> _,,�� ___�.,_c. . 7pr �t+r�i�.sc4-t' 'Lo(o- ���- 1�a' <br /> CONTRACTOR��{{�p�(( �S A GMV P �DRESS ' CITY2IP PHONE <br /> 3S2co �oo�u�No t wtuc Z.o6-l03'�- o8ao <br /> CONTR.LICENSE#��,F'OU 6 qq0�� Rv�• t�oa� �cYetti �gto3 <br /> iJSE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> CO 1rOb{riti N l V M <br /> J[Electric _Gas_Other �o O�O(1n • O tJ <br /> WORK�ESCRIPTION n� Q��� , ,1 S�p��. <br /> �a�j� �Ru�,�'�(� ��tw�ET - \� ��n <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE��R ITEM NO. TYPE OF FDCiURE OR ITEM <br /> Toilet � _ AIC—alr handling unlLs <br /> Bathtub _ Forcedairsystems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower __ Water heater <br /> Kitchen sink 8 disposal _ Gas flreplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> _ Laundrytray Rangohood <br /> Sink(service/badmop/etc.) _ E�aust fan <br /> Backflow preventer _ Heat pump <br /> Unnal : _ Unft heaYer <br /> _ Drinking Fountain _ Boiler <br /> Floordrain __ RefrigeraUon <br /> Grease Irap _ Woodslove <br /> � Roof drains _ Other <br /> Ofher — <br /> CITY OF EVERETt LOCAL SAI.ES SAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this appliratlon and know the same lo he true and cortect All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether saecfied herein or not The grantlng of a pertnit does not presume <br /> to give authoriry to violate or cancel the provision of any other stato or local law regulatlng constructlon or the perfortnanca of <br /> consWcGon.That I am authorized b/the owner of this properly to perfortn the work for which appl'Mztion is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296200 WAC. <br /> — Date ��L <br /> Signature of OwnerlContractor/Authoriz.ed Agent � <br />