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U�i\ � <br />iADDRESS <br />PERMIT APPLI�ATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98207 �I(� )� OS -_`�� <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />p/ � � <br />��(QJtC, `` PPLICATIONS ARE ACCEPTED FROM B AM TO4 PM .1�.-.�-�� `' �`� �! <br />PARCEL TAX I.D. N PLRMIT N / <br />}-1710D003600 � 7�'`� - _ `J'� <br />LE A OTNO. BL:i�N TRACT S�e c1N C�P�I <br />oesc 3� �} �� ) C�C� I Plai- oF nar��n�i-on Repla�-' oF Lc� X���e��,l �escr�p�i <br />OWNER ADDRE9S CITY?JP PHONE <br />Dn�; l w. � J'�y H. K�� <br />`i 717 ���ver�Prn /�ve ��ere+} 982U3 C4�s)3s3-�492 <br />TENANTNAME CONTACTFORPERMIT P ON <br />c3c.�� � -i469 <br />�°`v"� K'", C42j) 3S3-7y92- <br />COHTRACTOR (� {�ps� ADDRESB CITYIDP PHONE <br />�O�r S�arC��s�Hc��o,� In�. P.�� L3eX8 7� L.ukeSk�e,�y i3Eio)6�1-yro7 <br />coNra. ucer�se � FoU RSSL962'S}} `18 ?�6 <br />USE OF BUILDING <br />Srnyle Fam�ly Resiae���e <br />HEATSGURCE <br />Electric (Z �as _ Other <br />W�RK DESCR!PTION <br />o�is�ruct new s:n�le �um� �y resic�en�e.. rnc�� <br />liv�n9 s(�a�� � IIH3 F��- tihF;nis:��: br�5���ten�- <br />3f33 �l-2 �P�'�� �Pc �� Rnc� 2CJE� Ft�" c over e�� � <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toile� <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Launtlry lray <br />Sink (servicelbadmopietc ) <br />6ackAow preventer <br />Unnal <br />Dnnking Founlain <br />Fia+r dram <br />Greasetrap <br />Ruof drams <br />Other <br />CONTRACT PRICE OF WORK <br />Te� � <br />23�yL �r�2 ti�1i �1ec� <br />{-�'E2 de}acl,� JaraJe � <br />NO. � TYPE OF FIl(7URE OR ITEM <br />FVC — air handlmg unds <br />Forced air syslems (�,y� �,•�.�z <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Ctothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />BUIIer <br />Refngeration <br />Waods'ove <br />Olher <br />CITY OF EVERF.TT LOCAL SALES TAX CODE IS 7106 <br />I hereby cenLty that I have read and ezammed this 2ppllcaGon and know the same to be true and cbned. All prowsiors of laws and <br />ordmaces governing this type of work will be comphed vnth whether specified herein or not. The granting of a permd dces not presume <br />to give authonty to violate or cancel the proviswn of any other state or local law regulali�g construdion or the periormance of <br />wnstrudion That 1 am authonzed by the owner of this properry to pertotm !he work for wfiich application is made and I comply with the <br />State Contredors Law 1B 27 RCW and 296 200 WAC , <br />�I� <br />