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� � � �p �,,� .� �'��^_ua�� <br /> PERIV�Il' MPP�.iCA�'ION <br /> CITIf OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610- FAX 425-257-Se57-www.evereltwa.org <br /> ICAT S ARE ACCEPTED FROM 6 AM TO 4 PM /o --a3-a� <br /> SITE AD�RESS un�r � 3 PARCEL TAY, I.D.� PERMIT# <br /> Z5D(p 2uc.�ceti l��C 0`��� � 55 9o3ooC� INtog,io-o�3 <br /> I.BGAL LOiNO. BLOCK TRAG7 <br /> D[SC — <br /> OWNER ADDRESS CITYIZIP PHONE <br /> S`�� K-0.�.e— __��— (�z 3�--�-,s`� _ <br /> TENANT N�ME . �ZS CONTACT FOR PERMIT PHONE <br /> �'`�`c�(�- -���� ' Z58-(oY32, �- arl�..t,.... �-Q-�OS�-�-`�' �D��1 "1�-�GSg`6 <br /> CONTRAC R � - PHONE <br /> I�:j�����lr7l:' il�i �i. ;l�f� ADDRESS`^ySJ� ��(��n/;.��,�LCITY2IP .�1���.�� -- . <br /> I <br /> y� L, ,. ��� �. , �;. /�_�lk �:-, �') 5 � �`a\ <br /> CONTR.LI ENSE tl . " �� ��� =��.��' <br /> L�/`�-i�yl���i� il_ �j " _ - _ __ <br /> USE OF BUILDI�'G � , I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �qMJ � � 3�5� <br /> /�-S�J,n�_�f . /"j� '/� ✓Elrcliic _Gas_Other --.-.-- <br /> ' li' (�lt- Q.V .N/ <br /> f ' <br /> WORK DESCRIPTION n �a�� /� � � /�// /I�f <br /> CY � l_� ) ����(C Vv�"� `� r � <br /> I <br /> I - ---- --- PLUMBING — - -- — -f�1ECIiANICAL -- — <br /> NO. TYPE OF FiXTURE OR ITEM NO. NPE ol- I�IxTl1RE OR Il EM -- --- <br /> Toilet _ NC—airhandlinguniL: <br /> Balhtub _ Forced air sy::tr�rc: <br /> Lavalcry(wash basin) _ Gas piping <br /> Shower _ Water healcr <br /> � Kilchen sink&disposal _ Gas fireplac� <br /> � Dishwasher _ Gas range <br /> � Clotheswasher _ Clolhesdr;��:i <br /> Laundry Iray _ Range h��,�I <br /> �, Sink(servicelbadrnup/etcJ _, Exha�is�f.vi <br /> I � R��kllnw pieventer __ Heat pump <br /> '� Unn21 _ Uni11x��„t�:; <br /> � _ Drinking I'nuntoin _ Boiler <br /> I FloorJi,in _ Re(rigcr;�tion <br /> '� Grease liap _ W�odstove <br /> I Roof diau s 1 ,,� � p _ Other _ <br /> �'�� I Olher�W�_i—�-'Q"'t"`� — — <br /> _� <br /> � — <br /> CITY OF EVERETT LOCP�SALES TAX CODE IS]705 <br /> i <br /> �� I hereby cerilify ihat I have read and ezamined this application and know the same to be Irue and correct. All provisions of laws and <br /> i ordinaces 9oveming this type of work will be complied vnlh whelher speci(ied herein or noL The�ranling of a permil doee not presum�-� <br /> �� to give aulhority lo violale or cancei the pmvision of any other stale or local h �•^,n.ii.�iin9 construc�ion nr ihe per nrm;ince o( <br /> � conslruction. Thal I am authorized by ihe owner of Ihis property to perform Ih •• ��I�. lor�4hi�h ?t�^hr,:ition is mad: �nri I c��mpiy v,�lh the <br /> �� S ate Contractors Lav+ 1F327 RGW and 296200 WAC. <br /> �.9bStccc— �0 -2�-b�0-- <br /> li Si9nalure ol wner/ConlractorlAuthonzed�genl U�b.• <br />