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SITE ADDRE 3S <br />1�5oy 2;.1„J , <br />LEGA u � r r+o. <br />DESC. <br />OwNER <br />NAMi: <br />m�e ila; � <br />CONT AGTOP� <br />NIA <br />CONTp. UCEI ;E N <br />11SE OF BUIi,DING <br />WORK UESC I IIFTION <br />Tns-h�ll�� � g New <br />P�RMIT APPLICATION <br />CITY C;�F EVERETT PERMIT SERVICES <br />320D CEDAR STREET, EVF.ftETT, WA 98201 <br />425-257-8810 — FAX 425-257-SEt57 — www.everettwa.org <br />APPLIC:ATIONS ARE ACCEPTED FROM R AM TO 4 PM (� � �� � <br />BLOCK <br />Wa�r µe�� <br />TYPE OF Fl%TURE OR I7EI'd <br />I lel <br />thiut <br />valoi, (washbasir) <br />owei <br />chon ;ink & dl,posal <br />:h�var,tier <br />>thea vasher <br />a�er I�r.aler <br />ik (s� vice/badmo?/etc,j <br />cktlo proventer <br />nai <br />nkin� =ountain <br />ortli in <br />�ase I �ap <br />of dr � ns <br />�er— ----- <br />PARCEL TAX I.D, � <br />TAACT OR SUBDIVISION # <br />CONTACTFOR <br />HEAT SOURCE <br />_ Electrlc x Gas � Other <br />PEflMIT # <br />�\('19 (7�� -<k�� <br />%� <br />CONTRACT PRICE OF WORK <br />N0. � TYPE OF FIXTUpE OR ITEM <br />A/C — air handiinp units <br />Forcotl air systems <br />_ Gas piping <br />Water heater <br />Gas fireplaca <br />Gasrange <br />�, Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heatpump <br />_ Unit he2fer <br />Boiler <br />Refrlgeratlon <br />Waotlstove <br />Other <br />CI7V OF EVERE7T LOCAL SALES TA% CODE IS 9705 <br />I hereby canlif that I have read and examined this appucatlon and know the same to be true and correcL AII provisio�s of aws and <br />ordinaces gov� ninp this typo ot work vriu be : omplied �vith whether specllied herein or not. The graMing o( a permlt does n�t presume <br />to give aulhori� , to violate or cancel ihe provislon of any other sta�e or local law regulating conslruction or the performance ��1 <br />construction. l at 1 am authorized by the owner of thic prop?rty to pertorm (hp wOrk i0r which appllCa110� i5 rttade end 1 r,OnlDly tvlth the <br />Stflte Contract.�s Law 18.27 RCW and 296.F00 WAC. <br />�, � 6/17/ar <br />Signatufe of J^ ner/Gontractor/Author¢�tl Ag'nt Oate <br />