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P`tRIVIIT APPLICAiIGN <br />CI7Y OF EVERETT PERNIIT SERVIC�S <br />3200 C�DAR STREET, EVER[TT, WA 98201 <br />425-257-88 i0 — FAX 425-257-8357 — www.everetr�a.urg <br />APPLICATIONS ARE ACCEPTED FROM $ AM TO 4 PM - DEBIT & CREDIT Cf.RUS ARE WOT ACCEPTED <br />SITEADDR�S � <br />LEGAL LOTNO. BLnCK <br />DESG � <br />OWNER <br />Qr�.�san�N�s, a��. <br />TENANTNAME <br />C NTRACTOR <br />��'�,sRv.�D� �• <br />CONTR. LICENSE # ��T�C 11T � ` <br />J TT �L <br />USE OF BUILDING <br />S �- � <br />WORK DESCRIPTION <br />i�ik� � r � 1 '� �' J� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tailet <br />Bathlub <br />Lavatory (wash basin� <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Ruof drains <br />Other <br />PARCEL TAX I.D. # <br />\!1/1C/fi�__r1F1�— <br />� <br />COflTA�TFOR <br />�r�v � <br />P <br />.�a - <<-r�Ll <br />CIIY/ZIP PHONE <br />�'�-�E'13 Fve,� �wa�iK� <br />IT PHONC <br />:ri o. � <� O(� -�-I <br />ao� - <br />1Olo1AD�R�S�e�^�Y ^ CI1Y21P PHONE <br />� �-u�a ��r.se.+f �,,Y�p{ a�t�-UZ$-1�5u7 <br />HEATSOURCE <br />Electric I�Gas __ Other <br />CONTRACT PRICE OF WORK <br />�rp�et�� V�0.�rn�' <br />��� �� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Ezhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refngeretion <br />lNoodstove <br />Other <br />CITY OF EVERE7T LOCAL SALES SAX CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis application and know the same to 6e true and correcL All provi,ions of laws and <br />ordinaces governing this type of wurk will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give au!iiority to violate or cancel the proaision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contra tors Law 18.27 RCW and 296.200 WAC. <br />��.��� %uQ�.�, S D �s <br />Signature o�wnedC tr�ctoU uthonzed gent ate � C/J <br />