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FR019 :Evergre�'ri StdtF Ho�t 2 ' FRX FIO. :42`.259f�650 Ruc. 27 2�J38 2::41F+'9 PS <br />317E AODRESS <br />LOT N0. <br />OESC <br />PERIMIT APPLICATION <br />CITY OF E�/ERE7T PERMIT SERVICES <br />3200 CEDhR STREET, EVERETT, VJA 98201 <br />425-257-8810 — FAX 425•257-8957 — www.everettwa.org <br />APPLICATIONS Ah?E ACCEpTED FROM 8 AM TO 4 pM <br />BLOCK I TAACt <br />PARCEL 7AX I.D. N <br />�a-7�a?� <br />� <br />� " ��— <br />E l�'�2G'r"f � /�� ��Lh�';�'i � � ,?,o� �s /,'i°�9�1.,,a,� i �zs i .;? 5� .7 %%Y <br />TENANiNAME � I CONTAC7FORh'8RM17 PHDNE <br />_..���-� <br />CONTRAC70R ADORESS CITV/21P PHONE <br />L7/1.�1 � �YJL : ���'�' /%,�f'"7 - .�y/: -, . <br />CONTR�LIC[N/EM � �%LO/7jQC/F!C �Q24� �Jjt�p( r� <br />r �l�n / ri . -�.� . . 2 ✓�n. "' ���� I <br />U8E OF UU�LUINO <br />--/if 1 C.�L/� <br />c <br />ne�raouRct� <br />Y,,, Eiectrlc „ZCGe� _ pther <br />CONThACT PRICE OF WORK <br />. <br />_ �5z� �o <br />WORI( DESCRIPTION � <br />l o2•zc:rr' �'�9 � JJ�ioC. 7'a, />>G7L•�¢- f�zc;iz-: L/�G i?9rr�i(- <br />N0. I TYpE OF FIXTURE OR 17CM <br />TollOt <br />_ Bathtub <br />Lovelory (weah bacln) <br />Shower <br />� Kltchen slnk & diapocal <br />,__, Dlehweoher <br />Ctolhes wesher <br />� Laundry trey <br />Sink (servlce/Cer/mop/etc.) <br />,___ 8acktlDw pteVBntet <br />Urinal <br />, � Drinking P'ouNeln <br />I'loor dreir. - <br />Orease trap <br />� 12ootdrains <br />_ Other <br />N0. <br />TYPE OF fIkTURE OR ITEM <br />/VC – alr h6ndlinp units <br />Forced elr syctema <br />6as pipinp <br />Wster neator <br />Oae f ieplece <br />Oea ranpo <br />Clothee dryer <br />Renpe hobd <br />Exheuet 1an <br />Meal pump <br />Unlf haeler <br />Bollef <br />Refrlporatlon <br />Woodatovo <br />Other_ _ _ <br />CI"fY OF EVERETT LOCqL �ALES TAX CO�E IB 3706 <br />I herehy cedtlfy that I havo road and examined thle applicaUon and know the Bema to be Vue end wrrec6 All pro�isiona of lews end <br />ordinetos govaminA thla type of work will be complied with whether speci0ed hereln or not. The prantlnp o/ a porrtJt does not preeume <br />to glve authorlty to violate or cancal the provlslon ol any olher etate or locel low repuletlnQ conetrucUon or the peAoimanca o/ <br />conslrucUon. 1'het I em euthorizad by the owner of this pmperty to psrform the work for whlcA epplicellon b made and i compiy with the <br />Sla on etlors I�qw 78,27 RCW end 298,Z00 WAC. <br />l ... �'�l 7�,� � <br />-> � _ : <br />� _ _ . _ , . • <br />