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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />32L`0 CEJAR STRFFT, EVERETT, WA 98201 <br />42; 257 8G10 - PAX 42�i 25; -8857 - wv.�w.^varetiwaorq <br />�?( ��(� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �/Z -�Z <br />- ---- ---_ ------ --'-- --- ----- --- L <br />SITE ADDRESS `-- �`--� PARCEL TA% I.D. R PERMIT p <br />2o2b - llz� ST.��. 005374oao045o1 +00537`�0004Goc (__' J/l ' <br />_ - - _---- ---- --1------ -- - ---=z- <br />h� 1M � I.OT NO. BLOCK TRACT OR SUB�IVISION N <br />L�'��'� TRA(.TS 45+� �T OF PAiNG FIELD ADO * 2 <br />- -- ------ -- — ------ <br />OWN[R ADDRESS CITVZIP PHONE <br />M�P�woeo co�-r ��,c ia6o�--n+,encn.s.e. ��LLca�,c, 425•3S�-o28Cc <br />wA. 99oi2 <br />---- -- — ---------- ---- ------ --- <br />TENAN7 NAM[ � CONTACT FOR PFRMIT PMONE <br />� CONTqA�Tbli------------------A66�ES�- -- <br />CONTR. LICENSE p <br />USE OF BUILDING � HEAT SOURCG <br />StNGt.E FAMLLY ZcwNNou5E5 X o,•�.���� c,�, ou,��� <br />WORK DESCRIP7'ION <br />E�MAIL <br />CONTRACT PRICS OF WORK <br />OD <br />�aay 3v1 <br />__----->— <br />CGN572UCT A SINGLE PA��IL�{ TGwivµpu5E -��UN� ��7 <br />PLUMBING <br />NO. I TYPE OF FI%TURE OR ITEM <br />� lodet �--�-_ <br />Q Balhlub <br />�j Lavatary (wasli basn� <br />Shower <br />1 Kdchen slnk 8 Uiti�io ;al <br />I Dishwnsher <br />� Clothcs w�tslici <br />I_ _ Wntcr hun�m <br />_ Sinh �scrvicab�i mopb�c I <br />�achllow preva,iler <br />Uiinal <br />Urinking fountain <br />floai drmn <br />�- Gmasc Irap <br />Hool drams <br />Oihor <br />NO. I TVPE OF FI%TURE OH ITEM <br />I <br />� <br />a- <br />A�C - air handling unils <br />�orccd aii syslems <br />Gds piping <br />Water hoalor <br />Gas lirr,piace <br />Gas innye <br />Ciothes dryer <br />Rangchood <br />L=hausl lan <br />Hcat pump <br />�i Unit hodle� <br />[ioiler <br />Relrigmation <br />Woodslove <br />Olhc� <br />CITY OF EVERETT LOCAL SAlES TA% CODE IS 3105 <br />i' <br />i huret�y cerildy ihal I have road end exammed Ihis appl�cauon �nd know Ihe same to be Irue and correcl. All provisions ol laws and I <br />�ndinaces goveming Ihis lype ol work will be comphed wdh whelher sq�cihed herein or nol. The orant�ng ol a pcnnil does not presumc <br />lu grve aulhonty lo viol;ile m cancel ihe provision ot any olhei state or local law mgulaling construction or Ihe perlormance ol <br />�-onslrur.Uon. That I am �mlho�izud by Ihe owner ol lh�s propeity �o peAnnn Ihe woik lor e�hich applicaUon is made and I comply wilh Ihe <br />';tatc �ontiaclo�s Law td21_RCW and 296200 WAC. �, <br />/0-//-07 <br />����naIWUWQWnm'CMIVJCIor�llulpontCtlAgent vale - <br />��' � <br />� I <br />