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� <br /> I��RMIT APPLICATIGN <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 6 AM TO 4 PM � � 3fj -�7 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT�f <br /> Z87.o O#kKS ,AUs� 00 0 �'0 Rs - � <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> OWNER ADDRESS C�TY21P PHONE � <br /> 9� <br /> TEN 3NAME CONTACT FOR PERMIT PHONE ��'�p S ZS S <br /> V��GPS� a�.v�� g��NY E-MAIL �rP��,(��al.P�� <br /> tiv�z�—�xaaE �—� <br /> AL�Nc �2-�� S'�--� �hSr6-Yv�s IN�, '135 E }A,¢�•a�c�nl �Bu,¢,",�c��-erJ I�N.°►'�i33 <br /> CONTR.LICENSE N 3(oo�Ss S�y y <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> — — — Iyo00 � <br /> Eleciric Gas Olher <br /> WORK DESCRIPTION <br /> -��_ �`(�.. '(,�sS'Z. 1�ov0 (Cm�n m�„c,,�A� l�,�l�H� <br /> SN� �' S>. D.� ���5 � �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units� <br /> Bathlub Forced air systems ' ' <br /> Lavatory(wash basin) Gas piping <br /> Shower Waten c�ater <br /> Kitchen sink 8 disposai Gas fireplace <br /> Dishwasher Gas range <br /> Ciothes washer Clolhes dryer <br /> b'Jaler heater Range hood <br /> Sink(service/barlmop/elc.) Exhaust(an <br /> Backllow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby centi(y that I have read and examined this applicalion and know the same to be true and correcl. All pro��isions of laws and <br /> ordinaces governing this type o(work will be complied wilh whether specified herein or not The granling of a pertnil does nol presume I <br /> lo give authority to violale or cancel Uie provision of any olher state or local law regulating construction or lhe peAortnance of <br /> constructior�.That I am aulhorized by Ihe owner of this property lo periorm lhe work for which applicalion is made and I comply with the <br /> Slate Conlraclors La�v 1827 RCW and 296.200 WAC. <br /> Signature of OvvnedContractor/Authorized Agent Date <br /> �IZ <br />