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P��tMIT APPLICATICS�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.* PERMIT N <br /> � v Ql/�2 • M0410-d(� <br /> LEGA LOTNO. BLOCK iRACT <br /> DESC. <br /> NER ADDRESS CITY2IP PH NE <br /> 9S2o� <br /> .�✓i � $1nP.C��.e- I-�avumanc-� I511 G�a�d P�v.e . E✓v'2}} � 1��:" CyzS)3o3-C�3oo <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � �SkeU�'e I-�o�lema�n ��-f2s> 3o3 - aSoo <br /> CONiRACTOR C�a�L �f-�V�� ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE X �l E <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Sit/1�12..}tlyF'�t�.�.��p yyt,Q� Electric �Gas_Other � ����PPI�K <br /> E� <br /> WORK DESCRIPTION . <br /> �a s Iv��ef--�- I�,-b p�-� .exs �-�-��-i5 �i,t p l a ce . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR REM <br /> Toilet A/C–alr hendling units <br /> _ Bathtub Forced air systems <br /> Lavatory(wash basin) � Gas pipfng <br /> Shower Water heater <br /> Kitchen sink&disposal ,L Gas fireplace <br /> Di:hwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boller <br /> Floor drein Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and cortact. All provieions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or noL The grantlng ot a pertnit does not presume <br /> ro give a��thonty to violate or cancel the provision of any uther state or local law regulatlng constructlon or the perfortnance of <br /> construction.That I am authorized by the awner of this property to pbrform the work for which application is made and I comply with the <br /> State Contractors Law 78.27 RCW and 296.200 WAC. <br /> , ���- 10/(Q/0� <br /> Signature of OwnedContractor�Authonzed Agent ate <br />