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1 <br /> P�cMIT APPLICATIO� <br /> CITY OF EVERETT PERMIT SERVICES ` '` <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 42&257-8810-FAX 425-257-8857-www.evsroQwa.orp <br /> APPLICATION8 ARE ACCEPTED FROM!AM TO 4�IA I� �-7�-0 6 - <br /> aRE�pDRE a PARCEL TAX I.D.R O3 � <br /> �� 1 <br /> � �oT No. e�ocK <br /> oesc. <br /> • �1 - IJ"'� r 1-� . 1 <br /> �NAME � CONTACiT fOR�EItlNT 1� • <br /> � N� � + <br /> COtl1RACTOR QIM��� !8' GTY� �1101�,__ �� f�7 � <br /> jn1 <br /> �.���. �-�� ---- u�,L,lu,��,� �►��)�u.���►� <br /> ��J� � HEAT SOURCE CONiRACT MtlCE OF WORI( <br /> �...-�— —E� _�._� ,�IG,000 <br /> WORK DESCRIP710N <br /> PLUMBIN(i � <br /> qp, TYPE OF FtlRURE OR ITEM M�• TY�E OF FaTiJ11E OR REM <br /> Ton�c ac-w�w,aMw v�r�. ' <br /> Bathtub Forced ak�yatems <br /> _ Lavalory(wash basin) — �� <br /> Shower _ Wab►hsater <br /> Kitchen sink 8 disposal — G�TM�a <br /> � Dishwasher — Qa°� <br /> CbU�es washer C��� <br /> Water healer _ Ranpe hood <br /> Sink(servlce/badmop/etc.) — E��� <br /> _ Backflow preventer —. H��� <br /> Urinal Unk hesfs► <br /> Drinking Fou�taln — �� <br /> Floor drain — ��� <br /> Grease Uap — WOO�'° <br /> Roof drains a� <br /> Other — <br /> —I I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J106 <br /> I hereby ceri6fy that I have read and examined this applicatlon and kraw the same to be true and comed. All provfebne af Iw+s a�d <br /> oMinaces goveming this type of work will be complied wNh whether aps�'ied tierein or noL The prantlrp of a pemrt do�not preaume <br /> to give aut rity to viotate or cancel the provisbn of any other sfete or bcal law repula8ng conahuc�b�u►tlis P�lo�rtwn�a <br /> const cti n Thal I am authorized by lhe owner of this propeAy to perfurm the work for wh�h aPPlkatlon b made and I comply wltl�Ihe <br /> State o t dors Law 1 7 R and 296.2('0 WAC. <br /> ��� b3-3v -o!� <br /> Signature o ner/Contractor ut zed Agen� � ate� � ' �� <br /> � h . <br />