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PERMIT APPLICATIOIV <br /> C�TY �F EV�RETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8510— FAX 425-257-8357—wv�nv.everetlwa.org <br /> APPLICATIONS ARE ACCEPI'ED FROh18 AM TO 4 PM <br /> SITE ADDRESS PARCEL TA;[ I.D.# -R MIT i� <br /> 9305 11TH AVEVV o0534000002�0� �'r��2-�2. -�J� <br /> LEGAL LOT NO. BLOCK TRACT � C �._ <br /> DESC. � — <br /> OWNER ADDRE.;S qTV21P PHONE <br /> MICHAEL DARBY 9305 11TH AVE W Everett982oa 425-218-1854 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Jennifer Burgess 206-774-9499 <br /> CONiRACTOR ADDRESS CITV2IP PHONE <br /> WESCO 3909 196 St SW� Lynnwaod 98036 g00-398-4663 <br /> cor:?R.���Er,St u WAS H I ES971 OB <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Residential I �Electric _Gas_Other I 6308.00 <br /> WORI< DESCRIPTION <br /> Replace York 2 ton heat pump system <br /> PLUMBING MECHANiCAL <br /> NO. TYPE UF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–airhandling units <br /> 8athtub Forced air sys[ems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower Water heatc•r <br /> Kitchen sink 8 disposal _ Gas fireplace <br />� _ Dishwasher _ Gas range <br /> Cloihas washer Clothes dryer <br /> Laundry tray _ Ranye hood <br /> � Sink(service/b2r/mop/etc.l Exhaustfan <br /> Backflowpreven[er i Heatpump <br /> Urinal Uni[heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap __ Wootlstove <br /> Roof drains Other � <br /> Other <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All prwisions of laws and <br /> ordinaces governing this type of work will Ue compiied with whether specified herein or not.i he granting of a pennit does not presume <br /> to give authonty to viclate or cancel ihe provision of any other state or local law regulating mnstruction or the pertormance of <br />��I construMion. That I am authorizetl by the owner of this property to perform the work for which application is made ar.d I comply with the <br /> State Contractors Law 1827 RCW and 296.200 WAC. <br /> CIq1;,Y1/tlynetl Iry Jn�nlle tic�gnt <br /> ry I:N.[r=lenniri L'w9n�cdI0Pt10:6t ItPn'IL.awiFMI111tt51 <br /> J e n n i te r B u ry e s s ��w:.,, �r,.,�.,�,,,,����.,,�„�m,:��m:.�, <br /> Signature ct Owner/Con;ractoT7Authon_ad elt "' ' -'"-" " Cat= <br />