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l <br /> � PERMIT APPLICATION <br /> I 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 7 �-� � <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT N <br /> 26 IS U'�s.1' �wsino � � l00(v' 0�� <br /> LEGAI. LOT NO. BLOCK TRACT OR 9UBDIVISION� <br /> DESC <br /> OWNER PODRESS CITYIZIP PHONE <br /> TENANTNAME f��,� �1tP G d CONTACTFORPERMIT PHONE �.Q( �d-OS$2 <br /> Ktry o.�� � :.1� EkMv;� �'vn I �a,,,�� ���v �.�a�Ma��"���»«�.1.� <br /> L`bATk7C�T8'F�–� s—�ES� �iT`721�EAOA�'� v— <br /> VCtkor l�. ��c1e�.hcn{� �O g0'�, ss63 �rl.�a..� 206�740-0�2 <br /> CONTR.LICENSE� q90$ 3 <br /> USE OF BUILDING HEAT SOURCE CpNTRACT PRICE OF WORK <br /> t� V •/ �j pd0 <br /> D�n t� S��A�O Y�Electric Gas Other r 3' � <br /> W}�ORK DESCRIPTION(� .�I • �,.,� (!W�r� +'�aS� <br /> p }�On bk SOMa. �+11'�P�o� �i ��'.►Scw '��t�16� In��'A�� N <br /> �vh6�� <br /> e�tc�ciul, !l`�A�, �laerinl, �;«�st�, worL, <br /> PLUMBING MECHANICAI. <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FII(TURE OH ITEM <br /> Toilet A/C-air hand6ng unds <br /> Bathtub Porced art systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disFosal Gas fueplace <br /> Dishwasher Gas ranye <br /> Clothes washer Clothes dryer <br /> VYater heater Range hood <br /> , Sink(serncelbar/mopietc� Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Unnal Und heater <br /> _ Drinkmg Fountam _ boder <br /> Floor dram Reingeration <br /> Grease trap Woodstove <br /> Rool drams Othcr <br /> Other <br /> I — --- — — <br /> i <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J106 <br /> II hereby certdy that I have read and eKamined Ihis applicabon and know Ihe same to be Irue and cortect All provisions ol laws and <br /> ordinances govermny this type of work will be compLed wdh whether speciGPd herem or not The granM1ng of a pr.rtnit does not presume <br /> to grve a yNrweUte_2 cancel the provision ol any olher state or local law regula6ng wnstruchon or the perlormance ol <br /> const chon Thal I ar�.a�nn� owner of ihis property to pertorm the wod.tor which apphcahon is made and I comply wlth the <br /> State n rectors L N 7B 27 RCW d 29 200 WAC <br /> i - �/s8�o <br /> SignaWre o wne on �\Ihonzed Agent Date <br /> . �/2 <br />