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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TN(I.D.A' PERMIT N <br /> �`1 �5 c�Au��:.r ,a �"�ljG-J <br /> L[GAL LOTNO. QLOCK TRACT <br /> DGSC. <br /> OWNER AUDRE55 CRV21P PfiONE <br /> TENANT NAME CONTACT FOR PERMIT PI{ONE <br /> ,.L n�,�, -o -155S4v4 <br /> �.LD�� ti C_iJ��clr4 C�,z <'��A..+-`"�l� S�NA+�c-' 1 v����aa'�\ <br /> CONTRACTOR �Q���N,�� <�_�� pDDRESS'���� ��S CfTY?JP PHONE <br /> •_�•-1 �`?��+^� <br /> CONTR.LICENSE/ �' ^ �� " �a�j <br /> .���",NFSo��P�P 3bo-755 5444 <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �- 1 1 N <br /> [Icclric Gas Othnr ���ytj(J <br /> WORK OESCRIPTION <br /> l . l -`r.. �(, t , .., , i •,•�',.. • . ,�i-. � '�•75,.: ..-. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR REM <br /> __ Toilet _ NC-oir handling units � � <br /> ___ Oalhlub Forced nii syslems ' � <br /> _ Lovalory(wash basin) _ Gas pipin� , ��ti� <br /> ___ Shower Water healcr - <br /> .__ Kitchen sink d disposal ___ Gas fireplaco v� ��( '� <br /> __ Dishwasher _ Gas rango � � . � <br /> _ _ Clothes washer Clothes dryer \\� �_�'� <br /> --_ - Leundry iray ----- Range hood i <br /> _ Sink(servicett�arlmop/elc.) Exhaus�lan � <br /> �ack0ow preventcr __ Hca�pump <br /> Urinal Uni�heater <br /> _ Dnnking Fountain poilcr <br /> _ Floor drain _ Relrigeralion <br /> _ Grcasc Irap Woodslovc <br /> _ Rool diains �_ OlhcrL�.�'-,..�_i��,.i-. .. <br /> Olhcr <br /> pTV OF EVER[Tl LOCAL SALES TAl(CODE IS 7105 <br /> I heroby ceritily Iha�I havo read nnd examined�his npplication end know ihe same to bc Irue nnd corred. All provisions ol laws und <br /> oidinaces qoveming Ihis type ol rrork will be complied wllh whelher speci6ed herein or not.The granling of a permit does not presumo <br /> lo�ive nu�horily lo violate or cnncel Ihe provision ol nny olher state or local law regulating conslruclion or�he peAormance ol <br /> cnnslruclion. Thal I am nuthorized by the owner ol Ihis propehy lo Dedurm Ihe work lor wfiich applicalion Is made nnd I comply with Ihe <br /> Stnle CONractors l.nw 1027 RCW onA 29Q200 WAC. <br /> 1 �, �. '�---- �'. _ -' l -I �`1 I�I <br /> � <br /> Signalure al OwnedConlraclodAulhonzr.d Agenl Datc <br />