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SITE <br />�� <br />LEGAI <br />UESC. <br />PERMIT A,PPLICATION <br />CITY OF EVEREI'T PERMIT CERViCES <br />3200 CEDAR STREET, E`'ERETT, WA 98201 bO � �' i <br />425-257-8810 - FAX 425-257-b�57 - www everettwa or <br />g � <br />i , �:,� <br />APPLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE N07 ACCEPTED <br />� �L� <br />LOTNO. _ BLOCK <br />`NDM <br />TENANfNAME <br />� <br />� <br />TAX I.D. N <br />�1�� <br />CO TR CTOR AODRE53 <br />i�, �n �VoMe�. Jne. �an,� ��5 o�ner <br />�1 <br />CONTR. LICENBEN jl��`rYS}{YA�7J�C.,3 <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. �I TYPE OF FIl(TURE OR IiEM <br />T} <br />,7 Totlet <br />Bathlub <br />Lavatory (wash basin) <br />_L Shower <br />_L Kitchen sink 8 disposal <br />J_ Dishwasher <br />,�_ Clothes washer <br />_ Lsundry tray <br />Sink (servicePoarlmop/etc ) <br />B�ckAow preventer <br />Urmal <br />Drinkmg Foun(ain <br />Floor drain <br />Greasetrap <br />Roo' drains <br />Ot�er <br />HEATSOURCE <br />_ Ele^.Iric ✓Gas _ Other <br />�� <br />NO. <br />n PERMIT M ^ <br />)C�' �����3 �1,, � <br />DV� <br />fY/ZIP PHONE — <br />�e(di ��2(7�. �15-H3dG3ia9 <br />PHONE <br />� ���n��7'x�-�(1�-�'i�11 <br />�/ZR PHONE <br />u�-ti��-�ac,a <br />CONTRACT PRICE OF WORK <br />�i �� <br />� � � �7 <br />M C ANICAL <br />TYPE OF FI%tURC OP ITEM <br />ArG -av handling units <br />Forced air syslems <br />' 1, Gas piping <br />,�_ Water heater <br />� Gas freplace <br />Gasrange <br />Z Ciothes dryer <br />� Range hood <br />� ,�_ Exhaust lan <br />Heat pump <br />Unit heater <br />Boiler <br />RefngeraBon <br />Woodstove <br />_� Olher <br />CITY OF EVERETT LOCAL SALES TA%CODE IS �706 <br />1 heraby cenlify that I have read and e�amined this application and know Ihe same lo be h ue end correct. All provlsions ol laws and <br />ordinaces governing Ihis type ol work will be comphed with whelher speafied herein or not The g�antmg ol a permd does nol presume <br />to glve authority to violate or cancel ihe provision of any other state or loca� law regulating conslmction or the peAortnance ol <br />constiuchon That I am aulhonzed by the owner ql this proprrty to pertorm �he work lor which appGcation Is made and I comply wilh Ihe <br />State Conlrar,(ors Law 18 27 RCW end 296200 WAC. <br />SignaWreof wner/ ontractor/Aulhonzed gent Date <br />