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Nov. 3. 2011 11:08AM <br />SITE <br />LOT <br />NAME <br />cvniHu-rvn <br />(�(1 �1 V1C,� � h C. <br />CONTR. LICEN9E N _ _ _ <br />USE OF BUI�.pING <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />A25-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLiCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAIC I.D. il <br />BLOCK TRACTOASUBDIVISIONN <br />AD RESS C�TY21P <br />330 � Roc.Ke�el ler^ EV, q 8 zo I <br />CONTACTFORPEHMIT PHi <br />i�P.bb�� E.0 <br />Vo. 1451 P. 2 <br />PERMI7 it <br />✓1\l1�— <br />� 4 i5 �aroack.�a� Ea✓ q 8z�ai �{��5 �59 �olob (o <br />HEA730URCE <br />�Eleclric _Gas_Olher <br />WORK DESCRIPTION <br />I nSi�u I I d� �-�1e SS 1�0.�' �u n� �° <br />N0. I TYPE OF FI%TURE OH ITEM <br />Toilel <br />Baihtub <br />Lavatory (wash basin) <br />Shower <br />` Kitchen sink 8 disposai <br />� �ishwasher <br />Clothes wash¢r <br />Water heater <br />� Sink (serviceibadmop/etc.) <br />'� 6acktlow preventer <br />� Urinal <br />Drinking Fountain <br />Floor drain <br />� Graase Irap <br />R001 drains <br />Other <br />CONTRACT PRICE OF WORK <br />4�1o3�i0 <br />N0. I TYPE OF flXTURE Op ITEM <br />A/C — alr handlinp uni(s <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firep�ace <br />Gas range <br />Clothes dryer <br />RanAe hood <br />Exhaustfan <br />Heatpump <br />Uni� healer <br />Boiler <br />Refrigeration <br />Woodg��e �l,�P <br />Olher V LTI <br />CITY OF EVERETT IOCAI SALES TAl( CODE IS J10S <br />I hore�y ceritlly �hal : have read and examinetl lhis applicalion and know the sama to be Irue and correct. All provis�ons ol laws and <br />ordinaces governing this lype ol work will tre complled �vith whelher specilied herein or noL The grantinp af a permit does not presame <br />lo giva aulhorily lo violete or eancel tha provision of any other state or local law regulating construction or the pertormance of <br />conslruction. That l em authorized by the o�vner of this property to pertorm the work for which applicatlon Is made and I comply with the <br />State Contractors Law 1827 RCW and 296.200 WAC. <br />7P,h h'� P_ i�r�u.p� � I i� 3 l I <br />