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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVFRETT, WA 98201 <br /> 425-257-8810-FAX 425-257-3857-www.everettwa.org <br /> aPPLICAT10N5 ARE ACCEPTeD FROM 8 AM 1'O 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE P.DDRESS I PARCEL TAX I.D.tt PERMIT#C <br /> �27_t �;v ���Lr • v� � �'oS6266c � o19o� ��7J���--�Z <br /> iEGAL LOTNO. BLRGK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �_/�tvS.� 4"1F � . 233 �j � ITN Avc L� -SC�'7ibL `ff-/oZ �oC) 7q0 'SS?� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> P � 1.. ���.�c;i.�� (o�"T�r.v��r�� '�01M �2�00„� Fi�b) 36r -a�'if <br /> CONTRACTOR rRO.ST�{fi� P��CN�',vlcn� ADDRESS Q p,,.,r ?59°+? �,��P � PHON9C <br /> I�f , �1. � � <br /> CONTR.UCENSE il ���� G S T FI I d71 h�(� � I I� "u> 9!S�J 3 s�� ' �"�] I <br /> k� <br /> L1SE OF BLIILDING I - HEAT SOJRCE I CONTRACT PRICE OF WORK <br /> Electnc _Gas_Other � � � , S <br /> WORK DESCRIPTION ��y {��,,,�1 e y�i Sfi^9 C�b�� w1D�1� 7 ° fW � no W ', <br /> �' �, �y a�'� 7 � r /(�f. f�dd �z-� nrw 'h�n".P<�� �ar✓ .. ,^Irn��, lyf I <br /> I <br /> I 1'LUM8ING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR REM <br /> Toilel _ A/C--air h2ndling unils I <br /> Balhlub __ Forced air syslems <br /> Lavatory(wash basin) ___ Gas piping <br /> Shower __ Water heater �� I <br /> — Gas fireplace � <br /> Kilchen sink 8 disposal — � I <br /> Dishwasher _ Gas range <br /> � Clothes�vasher _ Clothes dryer � il <br /> i Laundry lray __ Range hood � <br /> Sink(servicelbadmop/etcJ _ Exhaust f..n �f;� <br /> BackOow prevenler _ Heat pump y I <br /> Unnal __ Unilheater <br /> Drinking Founlain _ Boiler <br /> Floordrain _ Refngeralion <br /> _ Grease lrap � .O hodstove�I.'t J_`•`i`�� i c ✓� ��r S <br /> Roo(drains <br /> Other — — <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS J105 I <br /> I hereby cenlify thal 1 have read and examined lhis applicalion and know lhe sama lo be irue and covecL All provisions of laws and <br /> ordinaces goveming Ihis lype of work will be complied wilh whether speciGed herein or nol.The granling ot a permit does not presume <br /> to give authority lo vlolate or cancel the provision of any olher slale or local law regulaling conslruclion or Ihe performance of <br /> consUuction.Thal I am aulhonzed 6y the owner of lhis propeAy to perfortn Ihe work for which application is made and I comply wilh the <br /> Slale Con ctors Law 18.27 RCW and 296.200 WAC. <br /> � .._. - 3 I I <br /> �;'C, ���� .��� 1 �1 � 4 DS <br /> Signalure ol OwnerlConlractor uthonzP.A ngenl ��1e <br /> i '�,.._.___�' <br />