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. - <br /> P��MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 ANI TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.A� /rc R <br /> U � 10�� � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE P E <br /> �^ . ", .r, q,,, �v .. vnn <br /> NANT qAME C NTACT FOR PERMR P�E <br /> �qc� H ovs e /11av� //VI���.a� ,�-�'i82o3 �zs 3o8s310 <br /> CONTRACTOR �,r ADDRESS CfiY21P PHONE <br /> CONiR.LICENSE K ��� � � �„„��0.J.J��� <br /> (�/1// �1 ./.IQ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Re�-��.�;U y`�— _Electric �Gas_Other ¢� <br /> WORK DESCRIPTION r �nd f (00 r �rea �� /b��X �3r� /� /3 <br /> �ldd+,� l—a�� o <br /> /4/.7S L ,d� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%7URE OR ITEM NO. TYPE OF FU(TURE OR ITEM <br /> Toilel A/C—alr handling units <br /> Balhtub Forced alr systems <br /> Lavatory(wash basin) _ Gas pipfng <br /> Shower Waler heater <br /> Kitchen sink&disposal Gss fireplace <br /> Dishwasher Gas range <br /> Ciothes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> BackOow preventer Heatpump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Rooi drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS�tOS <br /> I hereby ceritify that I have read and examined this appiication and know the same W be true and correct. All provisbns of laws and <br /> ordinaces goveming this type ot work will be complied with whether specified herein or not.The grantlng of a parmit does not presume <br /> to give authority to violate or cancel the provision of any other state or tocal law regulaUng consductlon or the perfortnance of <br /> construction.That I am authorized by lhe owner of this property to pertorm the work tor which applicatlon is made and I camply with lhe <br /> State Conlractors Law 18.27 RCW and 296.200 WAC. <br /> �'I� 6c"• /l�on N.�..,, �e�23—G <br /> Signature ot OwnedConlractodAuthonzed Agent Date �/ <br /> , <br />