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PERMIT APPLICATION ,��,� � <br />CITY OF EVERETT PERMIT SERVICES ;,;�•;����� <br />3200 C[CAR >TRE[T. EVFRFTT, N/A 98201 ��� I <br />42�-257-8810 - FAX •125 25i-8857 - www.everet�wa ory , <br />' � �- i <br />31TE ADDRESS <br />�t:2;a - 112TM ST. <br />� i. c.�i �ot �+o <br />U! Ki; � <br />�--- <br />OWNER <br />MQPL.� Woo� Co�R.T <br />T'NANT NAME <br />APPUCATIONS ARE ACCEPTED FROM 8 AM T_ . PM ; I�� //� �� <br />------- -� - -- - � --PARCEL TAR I D. p �---- PE�MIT p <br />5.E. Ioo5379odo045o1 +0o537�mo4Goo �L%%(' -/ J <br />BLOCK I TRACT OR SUUDIVISION M <br />ITRACTS 45�4b RAT OF PAiNH r1EL0 kD0 �' 2 <br />1— - -- -- ---- <br />ADDRESS CIiY41P PMONE <br />L�,c I/;G07- �IQD Gi2.5�E. MILLGR��IC, 425•357-028(0 <br />wA. 98oi2 <br />I CONTACT FOR PEFMIT PHONE <br />� E•MAIL <br />-C6NTiia�7bA--- ----------A6DRE55 —Z�6-----PHbNE—�----- <br />CONTR. LICENSE p �r � �� , � j '/ � �. �? !Z( (' � � ( / 1� . <br />1 <br />USE OF DUILDING MEAT SOURCE CONTRACT PRICE OF WORK <br />SINGLE FiLnu.Y "i�NNcu5e5 X fl�c�iir Gas O�her ��/5�+,�?„'-� -'�y1.�5�•` <br />WOHK DESCRIPTION <br />Cb1�572ULT A StNGL� FA��IL�( TOw�vµOuSE l UNi' �- � <br />.rc.� <br />2 <br />� <br />I <br />1 <br />i <br />i_ <br />PLUMBING <br />TYPE OF FIXTURE OR IIEM <br />i„�i,�i <br />i3����,i���, <br />Lavatury (wash basm) <br />Shuwar <br />Kitchen sink 8 Aisposal <br />o�si,W,si,�,� <br />CInILes washer <br />Wale� henler <br />Smk (serviceNar�mopie�c J <br />Llackllow preven�cr <br />Unnal <br />Uiinking Fountain <br />(looi dr�in <br />G�r.:�se iiap <br />Rool drains <br />O�har. _._._ ... _ <br />-- i -------- <br />, ����'���� � <br />�. %iLk% '_ � <br />'� _5e �'). f�f '� <br />N0. I TVPE OF FIXTURE OH I�EIA ��'�^ I1° � <br />A C- air hnnAhi,y unns <br />ro���d nir systcins <br />Gas pipiup <br />Weter healo� <br />Gns lireplace <br />Gas ritnge <br />Clolhes diycr <br />Hange hood <br />Exhausl lar� <br />Hcat pump <br />Unil heeter <br />Boilei <br />RFlnc�aratlon <br />Woodslovn <br />O�her <br />CITV OF EVERETT LOGAL SALES TAIt COUE IS 9105 <br />i ��� �u� ceniily Ihai I have read end examined Ihis �pphcalien and know Ihe same lo oe Irue and cerreG All provisions nl lav,� and <br />.��.�,:vs �overnnic� Ihis iype ol worh will be r.uinplied with wh�iher sperilied he�ein or nul. Thr c�ranl�ng of a permit does nol �v�sunu� <br />�� i�. �� aiAhoidy lo viohtc or cancel tlie provisiun ol any olhm etale or locul law regulalmg r,onslruclion or Ihe peAo�marce oi <br />� .nuct�on. Thal I am authunred by Ihe owne� of this properly to pedorm Ihe work lor which applica!ion is made a^a i coir�ply �•npi ih,: <br />'•.'� � yynlraclors L� A 7� RCW and 29620J WAC. <br />} ��a vta,,.�• � i� /O - // - 6 7 <br />� ��,��,awrolOwner onlr�cloi� uthorrzedAgcnt Date <br />/' J <br />c <br />