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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.everetiwa.org <br /> APPLICATIONS ARE ACCEFTED FROM B AM TO 4 PM <br /> SITE ADORESS � PARCEL TAX I.O.N PERMIT <br /> I W CPS'� � �vP�'D - 1� 0�651 0 lol Q 70�. ? � <br /> LEGA1 LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DFSC. <br /> OWNER ADDRE55 CITYIZIP PNONE <br /> �1MtILsE'i" �A�k Cd�oorninl;�Ms 143�D �1Cp5►►� l'b �ft�itC °18204 <br /> TENANT NAME 1CONTACT FOR PERMIT PHONE � /pdZ T�I I <br /> ���X CDR� JIN�NG�Y� ��L6�1J ���.Ma�JiM@k�1D�aAe�l�ta1. <br /> _�� �D , <br /> CONTH. LICENSE N <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> (,OI��IM��i�1� Eleclric _ _ _Gas__ _Other � L �Q�� �— <br /> 1 — <br /> WORK DESCRIPTION <br /> tz�E � �RwE s�o�sc� tt� � r�1.a.� �uJ�-APF �ia�rzs <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR I7EM NO. TYPE OF FI%TURE OR ITEM <br /> T,oilof . • . - � ' . .� NC���ir hanc pg unil3". � , <br /> — <br /> Ba�hlub Forced air syslems <br /> Lavalory (wasli basin� .. _ Gas pipinq <br /> ..- --� Shower ... Water healer <br /> ____ � Kitchen sink 8 disposal ._ Gas fireplace <br /> Dishwashm . Gas range <br /> Clolhes washer _ _ Clolhes dryer <br /> Watrrheater ___ Rangchood <br /> Sink(service/barlmop�etc.l __ Erhausl lan <br /> __ Dackllow pree^nler ____ Heat pump <br /> Unnal __ Unil hCater <br /> _ � Drinking Founlain __,. Boiler <br /> � Floor drain ._ Reingcralion <br /> _, Grease vap Woods�ove <br /> -- Rooldrams ._._. Olhei— _--- <br /> --- Othcr -- - ._ .-------------- <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3t05 <br /> I hereby centily thN I have read and examined this application and know tho same to be irue and r.orrect. All provisions ol laws and <br /> ordinaces goveming this type ol work will ba complied wilh whether specified herein or nol.The grant�ng of a permit does not presume <br /> lo give authonty to violale or cancel the provision ol any other slate or local law regulating conslrur.tion or the pertormance ol <br /> construction. That I am ainhorized by iho owner ol this property lo perlorm the work lor which applica;ion is made and I comply wilh the <br /> St Contractors Law 1827 RCW and 296200 WAC. �'7 <br /> l� Us 23 <br /> nali e ol O ier ontractorAu�honzed Agent a�e fl� <br />