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�� �. �,�.e ���� �- �"� ��-- <br /> i <br /> P�RIVI1� �4PPLICATIOid <br /> CITY �F EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-wuvw.everettwa.org <br /> PL ARE ACCEPTED FROM 8 AM TO 4 PM �b � '�,3.�� <br /> 51T[A�DRESS u���� PARCEL TAX I.D.k PERMIT# <br /> 2501� 2uc.�.eti 0 `�3q 1SS `1 0 ��06 I tilo�ic-n•5`�1 _ <br /> I GGAL LOT NO. 6LOCI( TRACT <br /> U[SC <br /> QK,���R AODRESS CITY2IP PHONE <br /> 54.a,�... Kw-�e___�_ �` __ z- a --r�s`� _ <br /> TFNAIJT NA�dE , Zs CONTACT FOR PERMIT PHONE <br /> v^r`��(�. -�(—w �+� ' ZSS-(vY3Z L wrl..�,.... W-Q-�OS�-�- ��1'1 �&-�GSg�S <br /> CONTR�C R . 7 rl-- AODRESS ��S �/y fl/�.���CITYIZIP PHONE ,� -.�,- - <br /> ��;,;:,����,��,:_��i� (� �, T' � �, �.� <br /> � - ��(, « /<. ��., �,�y��lx�r�, j�� 5 -Y���.;A <br /> ' CONTR.LI C-NSE p ^ �'j�� � � �' <br /> � �L�,�S/;'iTa ��� i(!�' / � ' `' �> <br /> US8 OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORIC - <br /> n Mc�.� ( � ,S S�' <br /> I )/-5��I,n� _n � ��`�_ �/ �'[leciric Ga< Otl�cr — � .. <br /> � lr pu�, aY .K< <br /> � WORK DESCRIPTION / / / • � / <br /> � G� �a,�a e � Ll � �2 c�/'rC (,lJ�� /�-�"f��L <br /> PLUMBING _ - - frl[CFIf\NICAI_ <br /> � i�p, TYPE OF FIXTURE OR ITEM NO. TYI'[OF FIY.IURH OR 17E1d — <br /> � Toilel _, AIC-a�r handlinq unii�- <br /> Balhtub _ Forced,a�r s�.�.�� n�e. <br /> Lavalnry(wash basin) _ Gas pipun,� <br /> --- Showcr _ Wa�erh..-nlri <br /> Kitr.hen sink 8 disposal _ Gas lirer'�:>� <br /> Dshwasher _ Gasran�r� <br /> - C'otheswasher _ Clothes�!�,��� <br /> Leundry'�ay _ Range hnu�.i <br /> � SinY (service/barlmop/etc.) _ Exhaust !a�� <br /> � - Backflrnv prevenlei _ Heat pum�'� <br /> .. U�inal _ Unithcat:��� <br /> Drinking Poun�ain _ 6oiler <br /> Roor drain _ Refnycr;lr.:c <br /> Grease�rap _ Woodstuv�� <br /> Roof drau s � _ \_ �� _ Olher_--.--_-. <br /> �_ OlherSpg��bZ��-j�"" _ - - . <br /> � CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 _ <br /> I hereb�cerilify that 1 have read 2nd examined Ihis application and know thc-same to be tme and correcl All provlsions of laws anA <br /> -.�dinaces goveming Ihis type of wo�k will be complied wi�h whether specified hemin or not The pranling ot a permi�dnes not presume <br /> i:�give authority to violate or cancel�he provision of any olher stale or local Itr:�i��gul;aling i.�;nslruc4on or the perform��nce uf <br /> ��.onstruction-That I am aulhorized by ihe owner of this property to perfomi th��work f��i �vhich�ppli�:+t�on is ma�h;an�t I comply with ihe <br /> �;iate Conlrectors Law tA27 RCW and 2962U0 WAC. <br /> (�� Q��..� �J.�.�bSl.�rL _o -2�-0 `�- - <br /> ';ionali�w•nerlCnniractor/�ulhnnzetl Agent �:�I'' . <br />