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I t <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEOAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM t AM TO 4 PM �� 7O�--�S <br /> bITE ADDRESS PARCEL TAX I.D.N PERMIT R <br /> 1011 FIC. /tVC-C 00 7 7 0 U - <br /> LE LOT NO. lLOCK T1tACT <br /> DESC. � I� 'OQ <br /> ONMER ADDFiESS CITYfnP �MONE <br /> PU(,�'SW��O K�DNEY CTRS I(�S P1��Fi� �t EVC-RETT qSX�I <br /> TEXANT NAME I CONTACT FOR PERMIT MIONE <br /> CWIfRACTOR ADOREft CITYTP PMONE � <br /> N��uw Wna. A[-�+w.�r�a,+ ��.c.. 33� cnES'r^"'r s i EVE�err 967�� N7S-33q-3 i � � <br /> CONTR.UCENSE• <br /> �11�l3.Oo�++^'u �i�15 �S <br /> USE OF BUILWqO I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric _Gas_Other <br /> WORK DESCRIPTION <br /> OrM0/.�i fON OF NOUSC <br /> PLUMBING MECNANICAL <br /> NO. TYPE OF fIMUR!OR iTlM NO. M!Or FIl{TUR!OR ITlM <br /> Toilet AIC-air handling unib <br /> � Bethtub Forced air systems <br /> Lavatory(wash basin) _ 6as piping <br /> Shower Water hea0er <br /> Kitdxn nink 8 disposal Gas fiieplsce <br /> Dishwasher Ges range <br /> Clothes washer Clothea tlryer <br /> Laundry tray _ Range hood <br /> Sink(servicePoarlmop/etc.) _ Exhaust fan <br /> BadcBow preventer Heat pump <br /> Urinal Unit heater <br /> Dnnking Fountain Bdkr <br /> Floor drain Refngeration <br /> Grnase trap _ Woodstove <br /> Rool drains Other <br /> Other <br /> CIT'OF EVERETT LOCAL SALES TAIf CODE IS 1106 <br /> I nereby ceritify lhat I have read and ezamined this application and know lhe same to be true and cortect. AA proviaiona of lews and <br /> ordineces govemin�thie type ol work will be complied with whether epecified hercin or not.The grenting of e permil dop not preaume <br /> to give aulhonty to violate or cancel the provision of any other elate or lucal!aw reguleting conahuction or lhe performmce of <br /> construction. Thal 1 am authonzed by the owner ol lhis property to periortn lhe work for which application is made and I comply with the <br /> State Coniradors Law 1827 RCW and 296200 WAC. <br /> _/'��.'/�i>�O y ./d7 <br /> sigi t�re ar�wner ont2ctor/Authonzed gen� t—� ate <br />