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( <br /> 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 /> ��p� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (� —Q�—O�' <br /> SRE ADDRESS PARCEL TAX I.D.M PERMR N <br /> tw ir 6449 -6g •00 . oq W�o,ir!l,00b, l,bj-/ <br /> LEGA l0T NO. BIOCK TRACT OR SUBqVIS10N R <br /> DESC. �j 6$ 3 Fve�e r�r REPc�T r�S R�Co1at� ��, Vo� . 4 P�6f 49 SNO Ctl <br /> OWNER ADDRE55 CITY2IP PHONE <br /> (�ry�r��.o. �J £ iitnainr+NE a. $KOTDAL IG02 �-Ifw � TT Evt12CTT <br /> iENANT NAME CONTACT FOR PERMIT PMONE y t S 21- �H� <br /> (�PrrLo .� J1Z wi� �.ARq e�u�Jw����eD�o�6���.t <br /> �F ES`� I� <br /> �3 � � <br /> CONTq.LICENSE I � <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> L1�-1=10E /RE-TA ` l, F Eleciric X Gas_O�her � �QQ� <br /> WORK DESCRIPTION <br /> RIPtAC��+G '1 «« Sitt A��F�+i+�S W iT++ LiKt FOR 41k ! RrR�cti w^t r�>S <br /> ���( �o A ?"CC�+ NOLu6Y �HFtiGL•�, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR 17EM NO. TYPE OF flXTURE OR ITEM <br /> Toile� A/C-air handling uni�s <br /> Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer C�othes dryer <br /> Water heater Range hood <br /> Sink(service/barimop/etc.) Exhaust tan <br /> Backllow preventer Heat pump <br /> Urinal Unit heater <br /> Drinkinc�Fountain Boiler <br /> Floor drain Relrigeration <br /> Grease vap Woodstove <br /> Rool drains i Olher �z F ���'�r-v a 3 <br /> Olher <br /> CITY OF EVERETT LOCAL SAIES TA%CODE IS 3105 <br /> I hereby ceritily that I have read and examined Ihis application and know the same to be irue and correcl. AII provisions of laws and <br /> ordinaces goveming Ihis type af work will be complied wilh whether specified herein or not.The granting ol a permit does not presume <br /> to give authority to violate or cancel the provision ol any other state or local law regulaling construction or the peAormance of <br /> conslruction.That I am aulhorized by the owner of Ih,s property to perform the work for which application is made and I comply with ihe <br /> State CoNractors Law 82ZRCNLand 296.200 WAC <br /> ��C( �"�i/�(.�-^� I-2o- zoo9 <br /> SignaWre of Owner/Contractor/Authonzed Agent ate <br /> l/� <br />