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( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> �200 CEDAR STREET, EVERE7T, WA 98201 <br /> 425-257-8810 - FAX 425-257-6857-www.everettwa.org <br /> APPLICATIJNS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMITq� <br /> I W �PS� � �ah� - 39 od365'I 0 lol Q 70�s - '� <br /> LEGAI. LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS .:ITY/ZIP PMONE <br /> �Ntt.'(�-SE i ;'4�.k CeNoornuJ;�Ms 143o W LAS►� �'V �ft�ifC °1820�} <br /> TENANT NAME CONTACT FOR PERMIT' ` - PHOIIE � fo62 �6211 <br /> ^����- ,�,� .IIN�NG�Y►� �1LD�' '"`+'� — "E-MAIL�JIMNJ�JFN/�41�Q�S. <br /> —�� � <br /> 'f$D <br /> CONTR.UCENSE p <br /> USE UF DUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> ' ' °' 2� 50 <br /> CO�������m Eleciric _.__Gas Olhm �' �_ <br /> WORK DESCRIPTION <br /> k�E � �f�E si�»st� t� � r�1.a'� �*tJ&�P� a�e�rzs <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ToiIM ' . � - � . . __. A/C-air handling units <br /> Balhtub _.. ForceA eir systems <br /> Lavatory Iwash basinl . __ Gas piping <br /> Shower __ Water heater <br /> Kitchen sink 8 disposal _ Gas lireplace <br /> Oishwasher __ Gasrange <br /> - � Clothes washer __ ___ Clothes dryer <br /> Waler heater _ . Hange hood <br /> . Sink(service/barlmop'etc 1 . _ . Exhaust lan <br /> __ Backflow prevenlm . _ , Heal pump <br /> � Urinal _ Unil healer <br /> �nnking Fountain __ Boiler <br /> F-IoOr drain _ Relri�erati0n <br /> _ Gre�se trap � ' W oodstove <br /> Rool drains ... Olhcr.________,.___ <br /> Othcr ._ . _ ----------- <br /> CITV OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby centily that I have read and examined O�is application and know ihe same to be true and correcl All provisions ollaws and <br /> ordinaces goveming Ihis type ol work will be complied with whether specilied herein or not.The granting ol a permit does not presume <br /> lo give authnriry to violale or cancel ihe provision ol any other slate or local law requlating construction or the parformance of <br /> construdion. That I am authorized by the owner ol thi;property to perform the work for which application is made and I comply with�he <br /> SI Contractors Law 18.27 RCW and 296.200 WAC. 7jpp'7 <br /> � Us 23 I � <br /> nati e ol O ien 'onVactovAuthonzed gent ��e I <br />