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PERMlT APPLICATION <br />CITY OF EVERET� PERMIT SE::VICES <br />3200 CEDAR STREET, EVERETT, WA 9II201 <br />425-257-8810 - FAX 425-257-8857 - www everettwa ory ,' j� -�h �j <br />L <br />APPLICA, IONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT GARDS ARE NOT ACCEPTED I <br />�ITE ADDRES� PARCF.I TAX I.D. p PERMIT p � � <br />T� � <br />� �i ' —..Z'��L l _v �t:1 �/ i�ZO�; Z �.LS�����I?% � �� �L `.L`�L�L �� '� <br />�FGAL �OTNO. BLOCK 1 7{�qCT � �. <br />OL°C I �7y-� <br />OWNER �—_�1_.��.1y_l/'a(�'/�_� .__ <br />ADDRESc C11VlLIP PHONE <br />I<<- Uxs ,s�i ��<< OK �7s�� G��s___ilst •�i<_i�� wJi >A133 <br />TENANi NqME �� CONTALT FOR VERMIT PHONE <br />i l�ir!':!_f1ec�%� --- I%a;;; _� f'��1�! --��� --�>_i S_3 4 7 , <br />CONTRFCTOR qD RE 5 CITY/ZIP FHONF. i <br />��r� s �r .�a�,�- rkfw�q ��� ilux� m;�iC��c�� �d�,-�p•`��Hv <br />[ON7R LICENSEp �r�i 5�yi15 ��p ��� �'I�LC�I:� � <br />USE OF BUILUINC' <br />�� a�. , i _ T �H � L <br />WORK DESCRIPTION �.��� ,� <br />NEATSOURCE <br />_ Eladnc �a<_ � Olher <br />� i' � l2' Sir,. . /19c� <br />„ �f. � �, <br />' � ) ,,' h, � _ .., l�� w� i��.��..� �.�aN/ <br />NO. TYPE OF FI%TURE OR ITFM <br />� <br />Totlet <br />Dathluh <br />Lavetory �wash bas�n� <br />Slwwer <br />Kitchen sink E disposnl <br />Uishwasha; <br />CloUies washer <br />Loundry tray <br />Sink iserncelbarhnop/elc t <br />Beckllow prevenror <br />Unnal <br />Dnolnng Fountam <br />Floo� dram <br />liflBS� 'fB'� <br />Roof d�a�ns <br />Orher <br />� ICGNTRACT PRICE OF WORK <br />, ���n.� <br />, � c �r 1 �. (� �',. <br />V I���' <br />e <br />jjr� I 4 `�,.� ���1/�., <br />i <br />NO. TYPE OF FIXNRE OR I7EM <br />_ NC - nu handlinp imtls � <br />__ For�d;.:isys'ems <br />_. Gns piping <br />___ Watnr h�±ater .?' _ I- 3 _ � j- 4 3 . <br />_ i;as hr�olace �_��------ - - <br />��s � �nqe � <br />r'lotnesdryer � �+ ^ ' <br />__ I ar.�r hood �/ <br />[.haust lan <br />-__- Hentpemp ° � • <br />� Unit hepta.• — -- --- �- <br />_ Boiler � — � Z � ___._ � <br />Reingerahon <br />— V�OOAYIOVP '-'j I f � . <br />Other �_�� � ' <br />CIiV OF EVERETT LOCAL SALES TAX CODE IS 7106 <br />I Mreby ron61y thet I heve iead and exemined th,x applica6on and know thn seme ro be true ond conect All prowyons ot laws end <br />ordinar.rs govxming this type ol work will bx cnmolieA with vvhethar specihed herain or nol Ihe granhr� of a permM does nct presume <br />to prve au�honty to violate or cancel ihe prows�on of bny other etah or lacal law regulatir.g wnstructron or tha perfonnance of <br />conshuc6on That I am authonzad by the owner al �his property to perform �he work Ior whicii apDhca�on i� made end I comply v.ith the <br />Stale Controcto�s Law 19 27 RGW and 296 200 WAC <br />f <br />' %<<��i � lr- �'�-�c <br />Sign rn o1 Owner�unvactonnuthonzntl Aoenf hn�w <br />�, <br />� <br />