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S -I��D <br /> PERMIT APPLIC�TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9R201 <br /> 425-257•8810 - FAX 425-257-8857-ww�v.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 9 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADORESS PARCEL TAX I.D.p I PERMIT M <br /> ��u�il�.l':�.w�� R�o��l nn3�inlwxn�;ilul "7 �� �� <br /> �- <br /> LEGAL LOT NO. BLOCK TRACT <br /> DFSc 19�:n�� .n�tih�ri .\-Y��I ILr rniii�.cd pLun. <br /> OWNER ADDRESS CITY2IP PNONE <br /> ('a.11�u S��ilalr I�:hl 1'�.i I'oull�l..\�r \ S�nh 'lIL{ Sf:�IIIi�.\\�.\ 'IHI11'1 <br /> TENANTNAME I CONTACTFOR PERMIT PNONE <br /> Hr.J(��aii .\..��. �1:n�di�li�l.iin��� IY.�-Y76111���v. 111 <br /> 1���iv��ii \1�urlr.. � <br /> I I C1Y.til- I:i.IG��I� \\:�� Sim�� 3611Ilrllr�nr. \1�.1 JHINIi <br /> CONTRACTOR .�.�t�� ADDRESS CITV2IP PHONE <br /> CONTR.LICENSE N <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> \ .� �1.7.uuo.uu <br /> l'��num�irril u�cnl Eledric Ges Oihei <br /> WORK DESCRIPTION <br /> H�i���:dr��.niwcP.����i :uib�uu�.n��ndn Lmldmcn�,�li��p. I'I��:nr.�rrwi�nrdl'nqrnU��.��iipu�nilinin�nrd��bulydml��nnum�m. <br /> PL��MBING MECHANICAL <br /> N0. IYPE OF FI%TURE OH ITEM NO. T'PE OF FI%TURE OR ITEM <br /> Toilel AIC-air handlm�unds <br /> Balhtiib Forced air sys�ems <br /> _ Lavatory�wash basinl _ Gas piping <br /> Shower N,ater heater <br /> Kilchen sink 8 disposal Gas firepl2ce <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Leundry tray Range hood <br /> Smk�service/badmopretc i Ezhausl lan <br /> BackOuw prevente� Heal pump <br /> Unaal Und heater <br /> pnnking Fountam _ Botler <br /> Floor drain Reh igera�ion <br /> G�ease trep Woodstove <br /> Rocl drams Other_ <br /> Olher <br /> CITV OF EVERETT LOCAL SALES TAx CODE IS�105 <br /> I heieby cenufy thal l have read and exainmed thre appheauon and know Ihe same to be true and wrrect .411 provisions ol lews end <br /> ordinaces govemmg this type ol work w�ll be complied wRh whether specdied herein or not The granhng of e permil does nol presume <br /> �o yrve a Ihordy lo violate or cancel Ihe provision of eny olher state or local Isw regulatmg conslruction or the perlormance of <br /> constru �on Thal I m aulhonzed by lhe owne�oi ihis property to periorm the work Por which appl�cetion Is mede and I wmply with Ihe <br /> State Co Iractorp aw 18 27 RCW and 296 700 WAC <br /> '� � _- � _ .._. � � �� l e " � �� ! <br /> Si e r� W o a t I . ed Age�it aie <br /> i <br />