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Q <br />PERfMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S'� R[[T, EV[R[TT, WA 98201 <br />425-257-8810 - F. �X 425-257�8857 - www evereltwa.org <br />� <br />APPLICATIONS ARE ACCEPTED FRGM P AM TO 4 PM <br />�'f � ,'--' • j <br />-- --- — �—�- - --- - - -' <br />SITE ADDRESS � � PARCEL TAX I.D. N ] P�RMIT N <br />_�Reewp�.�{ —� �ac e � Pe-�Ys Plac.c_� � r7 3°-000�� 7 �-00/b13 -(b l �- ` ' � ' �-_ <br />ICGM LOTNO. BLOCK TRACT "" .� <br />nt sr. •�a ���_L�b_D_-00� 5�'c.ve72., �U� 3 <br />OWNER AD�RESS CITVITIP PHONE y�-asl-(,IfO <br />tJo��0.�i�R� ���ri'n�a�rt-r� !P�lS 7a.ro PniE S Kar.�r k/►4 9Yo3Z <br />TENANTNAME <br />N�R' <br />CONTRACTOR �0 8� ljr�,-^f�M�/,�CS� <br />CONTR. LICENSE / <br />USE OF BUILDING SiN� �C- F�'A�� (� <br />ReSiC�e�1'iia� CCouoon:u;w, <br />WORK DESCRIPTION <br />-ro +(�NSTrru�-*- 1 SlNGLe <br />NO. <br />PLUMBING <br />TYPE Of FIXTURE ON ITEM <br />I Todel <br />[lalhtub <br />lavatory (wash basinl <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />' I.aundry iray <br />;�nk (5?Nicelbar/mopletc I <br />�ackflow prevenler <br />Unnal <br />Dnnking Pounlain <br />Floor drain <br />Grease Irap <br />Roof drams <br />Other <br />COiJTACi FOR FERr �T � PHONE <br />�,cJAy ►�e Fb+�r y2S- (�Sb- 7Y3,S <br />ADORESS CITYIZIP PMIONE .� , ; <br />`��> >.C�� �/ � � G `� '7U� <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />� �Sf : <br />_ _Gleclnc VGas_Other ,�'����� �j <br />Gi�"7�11C..� J/rin�� WNZiOiMiM�lw� uAll� <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas pipi��.g <br />INater hrater <br />_�_ Gas fireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />� Exhauslfan <br />Heatpump <br />Unit hea�e� <br />f3oder <br />� Reingeralion <br />Woodslove <br />Olher <br />CIN OF EVERETT LOCAL SALES TAl( COOE IS 7106 <br />I he.eby cenhty Ihal 1 have read and exammed tlus applicaaon �nd know the same to be Irue and cocetl All provisions ol laws rnd <br />ordinaces govemmg Ihis lype of wniA will be comphed vnlh whelher speGfied herein or nol The granung of a permlt does not presume <br />lo grve authonly to wolate or canu�l Ihe provisron ol any olher stale or local law regulatmg conshudion or the perlormance of <br />conslru on That I am authonzed by Ihe owner ol this propeny lo peAo�m Ihe work for which appllcation is made and I compty vnlh the <br />Ftat� C� rac/to�/rs aw 18 27 RCN/ �7�'?�CO WAC <br />� _ UI ��%(/i>,/G'_ �%2���(/4 _� �� � Z l'Gi'f <br />- ---- ---� -- <br />! . <br />