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� <br /> PERMIT APPLICA.TION <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 C� �� ��� <br /> I SITE ADDRESS I PAACEL TAX I.D.N PERMIT M <br /> � � C s L �us��.� �� I C' �� �c -� <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> DESC <br /> OWNER AUDRES CITYIZIP PHONE <br /> �� I �•,� t40 C �Asr'�o f�<<I Cor�c $zo3 �o,� -9nz c� 3.� <br /> c ��� � cY S d r� � I � � <br /> TENANT NAME CONTACI FOR PERMIT PHC .E <br /> .. . p�( `J u✓�`F <br /> E�AAIL <br /> CONTR.UCENSE� <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �Electric _Gas Olher <br /> WORK'DiESCRIPTION <br /> f� , �� [ �'L/1 (l��nnc�C � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FUfTURE OP ITEM <br /> Toilet A�C—au handhng unds <br /> Bathlub Forced air systems <br /> Lavalory Iwash basin� Gas pipmg <br /> Shower VYater heater <br /> / x Kitchen sink 8 disposal , .�1.�n�� (�nnr(S ��� ' Gas fireplace <br /> � r Dishwasher N� f^ , � Gas range <br /> Clolheswasher �c� n� �.r. at �wn,E�" — <br /> _ r � � Clothes dryer <br /> Water healer r.•i�., � r,�+�+r �- � Range hood <br /> _ Smk�servicelbaUmopietc 1 ' � ��' "' � E■haust fan <br /> I Backflow preventer Heat pump <br /> I Uimal Und hea�er <br /> �'� Dnnking Fountain Boiler <br /> ' Floor drain � <br /> '�i Grease trap Wootlstove <br /> '� _ Roof drams � Other� a ' ' wt <br /> Other <br /> � CIiY OF EVERETT LOCAL SALES TAX CODE 18�105 <br /> �� I hereby certdy�hal I have read and examined this application and know Ihe same to be true and correcl All provreions ol laws and <br /> � o�dmances goveminq this type of work will be comp6ed with whether specified herem or not The grantmg of a permil does not presume <br /> to grve authonty to wolate or cancel Ihe proviswn ol any othei state or local law regulating wnstruclion or the peAormance of <br /> construchon That I arn authonzed by the owner of ihis property to perlorm the work for wnich apphcahon is made and I comply with the <br /> '�. Stale Conti ctors L w/18/27 RCW and 29G 200 WAC <br /> ' ,•_...�.b� �GV �ji/Z/iJ <br /> �I $ignature ol O er/Con�ractorlAuthonzed Agent Date <br /> I <br />