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�RMIT iAPPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET f, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITF ADDRESS PARCEL TAX I.D.# PERMIT# <br /> y2�s" rtdortsonl Rvr . � �pSSol �0 l02 I Cc����.rJUS <br /> DESC. L�NO. BLOCK �P� �— Q� <br /> OWNER ADDRESS CITY2IP PHONE <br /> ,�iEt�R,tc�f C�asr. Idc . 1408 '�ET'�Sr. SD,� C+r�FTi 9�2n3 �� ,�6•7716 <br /> TENANTNAME CONTACTFORPERMIT Ph:JNE <br /> CRiS G�u�2co,J ��r- �6•?716 '•` ; <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> 4ctl.ras�.J co�lsr. �,��. �?o•8aX 3�cs- E�-,�tt 482�3 4zs-356-77�b <br /> CONTR.LICENSE# . � • <br /> C�c�cE�c�o99mE <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> pi�14lE �iu/ �, _Eleclric �Gas_Other I I �� . 9 / 7 • (fi � <br /> � �� <br /> WORK DESCRIPTION � <br /> 1�lEul C0�lStRUCY�oiJ o7�� I I� L��r'�y <br /> yi3 � c�w�ac <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Toilet�i� A/C–air handling units <br /> 2 Balhlub�i _f_ Forcedairsyslems <br /> 4 Lavalory(wash basin) �i 1 i _L Gas piping <br /> I Shower � J_ N'ater I�ealer <br /> 1 Kitclien sink 8 disposal I Gas fireplace 1 <br /> i Dishwasher J_ Gasrang� <br /> I Clolhes washer Cfo�hes dryer <br /> Q_ Water heater �_ Range hood <br /> i Sink(serviceNar/mople�cJ � S Exhausl tan�t I 1-1- <br /> 6ackllow preventer Heal pump <br /> Urinal Unit healer <br /> Drinkin� Founlain Boiler <br /> _ Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritify that I have read and eramined Ihis applicalion and know the same to be We and correct. All provisions of lawo and <br /> ordinaces c�overning lhis lype of work will be complied wilh whether specified herein or noL The granting of a permit does not presume <br /> to give authorily lo violale or cancel Ihe provision of any olher stale or local law regulaling consWclion or Ihe periormance of <br /> consiruction. That I am authorized by the owner of this property to peAorm Ihe work for which application is made and I comply with the� <br /> Stale Coutra lors Law 18.27 RCW and 296.200 WAC. <br /> C`--�.�� J��, �o �o C �u� �'� <br /> Signalure o(OwnedConlractor/Authonzed Agenl �— Date � (,,,y(' ,� <br /> ?��� �= �' � -�1ve�''` �� L <br /> �i�'— <br /> � <br />