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' (� _ � <br /> PERMIT APPLICATION <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 AHE ACCEPTED FROM 8 AM TO 4 PM ( <br /> SITE ADDRESS PARCEL TAX I.D.�/ PERMIT# � <br /> �Zoo �� ►��;�� W �i DD Z - 3 � <br /> LEGAL LOT N0. BWCK TRACT OR SlIBDIVI510N p i <br /> OESC. <br /> OWNER ADORESS CRVRIP PHONE , <br /> l'e 6 00 /�lxrr,'!1 G�.ek Parkw�..� &DCi �oo,Su�fe. IOC �✓e�"�PHOYE�IZS•�J$L-D`�J$yo00 � <br /> TEN T NAME ONTACT FOR PERMIT � <br /> %G�(✓e I ,S�eJQ�'1 l�r10�S EMAILS��EnkQ�S-hJuc. ` <br /> _ �ii �'"� <br /> GQ SyS�eMs, Z"�• 72oz niE I�S� l�e.+�+o�e yl5- yYz-osky <br /> CONTR.LICENSE p 9�IO2S� <br /> GBsySI'�688B5 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> !�/ ,�1 60 <br /> _Eleciric _Gas_Other � �i /K>v' <br /> WORK DESCRIPTION <br /> �eloca}� l hnod , InS�ll ! Uf�7�}y•ScI' exhnul-5- �wn ond I beX �an, �elocc.}e <br /> Gnhau,s� <br /> 3 Louve�s and al� nessasa+�/ duc.� werk . <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIl(TURE OR ITEM <br /> Toile� _ �C-air handling units <br /> Bath�ub _ Forced air systems <br /> Lavarory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal ,_ Gas iireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes dryer � <br /> Water heater Range hood � <br /> Sink(servicelbarhnop/etc.) 2 Exhausifan <br /> Backflow preventer _ Heat pump <br /> � Urinal _ Unit hea�er <br /> Drinking Fountai-� _ Boiler <br /> Floor drain __ Refrigeration <br /> _ Greasetrap Woodstovo <br /> Rootdrains __L__ O�herFlne�d D�.+c�j/14fk <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify thal I have read and examined ihis application and know the same to be true and correcL All provisions ot laws and <br /> ordinaces geveming this Iype of work will be complied with whether specified herein or noL Tne granting of a permi�does not presume <br /> to give au�horiry to violate or cancel the provision of any other sta�e or local law regulating consiruction or!he performance of <br /> �,�s�ruclion.That I am authorized by the owner of�his property to perform�he work for which application is made and I comply with the <br /> Slate Contractors Law 18.27 RCW and 296 200 WAC. <br /> �-�-;,_,� �C„�,,(',�„___ .? -�� - (� <br /> SiynaWre of OwnedConlraclor/Authouzed Apent ate <br /> ; <br /> H; <br /> ,:. <br />