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- t <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAP. STREET, EVERETT, WA 98201 <br /> � ` R 425-257-8810—FAX 425-257-8857 —www.everettwa.org <br /> iy�f � � r ;i t ir ' APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /�� �9✓��J <br /> SITE ADDRESS PARCEL TA%I.D.N PERMIT• <br /> 30o KQ4LH 7t.q,L RD g�tx,. C � U C <br /> LEGA LOT NO. BLOCK TNACT OR 9UBOIVISION/ <br /> DESC <br /> OWNER ADDRE39 CITY2IP PHONE <br /> �.GMMUNISy '(pNV6'L'� '�loo Nnaoe,�,N ao. eueu.cr* / 9sw3 �y4S� �35 "1433 <br /> 1ENANTNAME I CONTACTFORPERMIT PHONE (20�1 255 - 4930 <br /> Cor�r.�uN TyptS�-u J[W.f� 5M1QP'1 E�YIAIL 3q�ttSOBA`1�.E`I.NCT <br /> B'�WIEV �NSTA-ULL10N <br /> CONTR.UCENSEI gpy��o3�SC �OOS Sf 28TM Sf. MeLCE41�0/ (�ub) b21 - bFb�{ <br /> 96oVo <br /> USE OF BUILDINO HEAT SOURCE CONTRACT PRICE OF WORK <br /> REtraooM C+c�ru� I ✓Electnc _Gas_Other �� I � <br /> WORK DE3CRIPTION <br /> Pt-'0(C..1.k.. TlMPo¢nay QE�ZM1wM FwC�u-1Ty ou-csiDE oF CiW�•. C oN NnITN VU�SS G.n0.t1ER <br /> F,a c..».w,vv �wau u+ec a�.a-vu. 3�oc,. C /.FJKooe� <br /> PLUMBING MF_CHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> 4 Toilet � �" NC-air handl� g units <br /> Bethtub � � Forced air sy. ems <br /> 4 Lavatory(wash bas�n) Gas piping <br /> Shower ' � Water he r <br /> Kdchen sink 8 d�sposal Ges fir ace <br /> Dishwasher � Gasr ge <br /> Clothes washer Clo es dryer <br /> i Waler heater nge hood <br /> 1 Smk(serylcelbarlmop/etc� xhaust fan <br /> � Backllow preventer Heat pump <br /> 2 Unnal Unit heater <br /> Drmk�ng Fountam BoBer <br /> Floa dram - Refngeration <br /> Gr `asn trap — Woodstove <br /> R Idrains Othe� <br /> 0 er <br /> CITY OF EVERETT LOCAL SALES TAX CODE 19 N06 <br /> I hereby certify thal I have read and examined Ihis epphcation and know the same to be true and correct All provisions of taws and <br /> ordinances goveming this type of work will be comphed wdh whether speufied herein or nol. The grandng ol a permit does not presume <br /> lo grve authonly to violate or cancel the provision of any other state or local Inw regulating construcUon or lhe performance of <br /> wnstrucGon That I am authorized by the owner of this property to peAorm the work(or whlch appGw6on is made end I comply with the <br /> State Contra6�ors Law 18 27 RCW and 296 2�0 WAC. <br /> � �� �� r &+r�er caNs:e�v,o J 5 <br /> Signatufe o OwnerlConirattodAuthonzed genl � a� I <br /> �------------ --- � <br />