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09/13%2005 12:M12 P:1\ 25a8599iJ6 NERNAVSO\ ENC./C.4D f�003/004 <br />� � <br />SITE ADDRESS <br />� <br />LEGAL LOT N0. <br />�ESC <br />OW�N�E�R�, � (� <br />�""i`+�'_TY1� <br />TENpNjNAME <br />PERMIT APPLICATION �iC W � ����5 <br />CITY OF EVERETT PERMIT SERVICES %� ��!� J�'.l <br />3200 CEDAR STREET, EVERETT, VJA 982C' `� <br />425-257-8610 - FAX 4: 5-257-8d57 - wc+w.ev=_retN:a.crg ' n/ � <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �I U� G,L�Q� <br />BLOCK <br />PARCEL TAX I.D. F <br />OR <br />I PERMIT # <br />_ I �S�r e3i <br />FHONE <br />r V".� ^ <br />CONTRACTOR - {� (�\('�,r'1�I"� A�DRESS CITY�ZIP HONE C C(�"Y'1{� <br />1l.i � � 12z�1� 2�n1d �Z f1. 2G`L.. ���� ���. <br />CONTR. LICENSE C �p'M!� �1(�/�� (]t �WiYI.�' / �Ji , �` <br />� �U � � x-'� W 11� �U1J32__'"_— . <br />USE OF BUILDING I HEAT SOURCE . =ONTRACT FRICE OF WORII <br />�f � A � _61=c'rc _Gas_O:her I C.z31 `J 1 � _. � <br />W��SY ��l,ll.., `'^'� .J1.1 <br />d�-(�s,�.rs , <br />�`nS�a.`� r�e,<,.� d�c+ux���c <br />d�l O �4 �' <br />N0. I TYPE OF FI%TURE OR ITEM <br />To:lel <br />Balntub <br />Lavatory �wasn bas�n) <br />$hower <br />Kilchen sin'e 8 aispcsal <br />Dishwasher <br />Cb:hes washer <br />Laucdry Uay <br />Sirk (servicelL•adnopletc I <br />Backllow prevenbtr <br />Uiinal <br />�rink�ng Fountari <br />F,00r drain <br />Greace trap <br />Roof Crains <br />Other <br />� <br />N0. I 'YPE OF FIXTURE OR I7EK <br />� A,C-��: rar'.In�unus <br />_I Forcea av syst=cs <br />_I Gas P.aing <br />. Wa'er neatz� <br />—� Gas (replace <br />Gas range <br />Clo:hes aryer <br />� RarSe ho-�c <br />—� cnhaus: Izr <br />Heat ocn•c <br />_�I Uri: heztcr <br />�o ,er <br />_� Reh�gc'a',c'� <br />I Vdocaetr�_ <br />�I o�,F� u_ rIG�" <br />I <br />CITY OF EVERETT LOCAL SALES TAX COf]E IS ]105 <br />I nereby ceritify that I have read and exammetl tnis appli�aion ana know the sa.ne to oe Ir;,e a�e cortecL All provisions of lav:s and <br />crdinaces govemi�g this lype of v,orrt w�,ll bz corp�ied w�.th w^.ether specified'ne�ein or nct T�z grantin� of a perm:t aoes not pres:me <br />to give autnority to v�.olate or cancel the provision of any othzr state cr local law regu.al nc ccnst•..c;icn o: Ih�: oer`ermante of <br />con ru uon. That I am aumcrzee by the owner of :his prepe�:y io pertorm tne wo�+ for v�h�ch appLcation s maae aad I comply w:tn tne <br />Sta C Nraclois La 8'i RCW ano 2 61CO VJAC <br />0.�,� . .. . , ��„`�1�91c�.s <br />