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�pr 27 07 ]1:39a �rea 2066221117 p.2 <br />; PERMIT APPUCATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEpAR STREET, EVERETT, WA 98201 <br />I 425-257-8�10 - fAX 425-?_57-8857 - www.evere�twa.org <br />I APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� SITE ADDRESS PARCEL TAX I.D. # <br />212b I��TH �>f1Z�T'� 2f30S2�1 00 2 0 1 500 <br />LFvA L�OT NO. BLOCK THAC7 OR SUUDIVISION M <br />I <br />nFti� �T_' SCC /Sr f7%�C�i1'El7 A <br />� H� . �, M�,,o� 51RCLT ��m-� <br />- '�� io4 <br />i 7ENAN� NAME I COMACT fOR PERMfT <br />rlor� c <br />� �SeC C�V+Z1/�NO <br />CONTPACiOq J.C•h1�wt�N coNc,T'• anoRess arv.mr <br />CONTR.LICENSEp P� F��X fobbL 6nMoNnS <br />��Ncwc c�83�c q6oz(o <br />I USE OF BUIIDING <br />�'!jCl�`i1' <br />WORK O[SCRIPTION <br />I_ <br />po. <br />V�h� C l—I 1-1 G 1�1 . <br />TYPE OF FI%TUNG 00ITGM <br />�ailei <br />� _ Balhlub <br />Lnvatary (wash 6osinl <br />i — Showci <br />HdChen 5ink 8 illsposal <br />, Dishwushcr <br />--_ CIpIIlAS WdSI1Cf <br />Walen c�atcr <br />.._ Saik (scrvice;barnioµetc.l <br />Dackllow p�eventer <br />Unnal <br />Unnking Foun�ain <br />I-loor Jrant <br />Grease Vap <br />flool drains <br />O�hcr <br />.i'ERMITN j <br />�, �C��' G�l � I <br />I <br />HONE <br />� 6 6 22 oo5y <br />PHONE <br />20�.83$.��50 <br />PHONE <br />7-a� 9-2 � �4 <br />HEAT SOURCE I CONTRACT PRiCE OP WORK <br />✓ Elecinr, cp; oihcr <br />NO. I TY�E OF FlXTURE OR I7EM <br />. n,c - mrnanaung unrts <br />Forced air systems <br />_ Gas pipiny <br />Water iiealc� <br />Gas f�replace <br />_ G.15 r��tqe <br />_ Cio�hes Aryer <br />Rmige hood <br />F Kha us� lan <br />_ � lieatpump <br />._ Unit hcaiur <br />�atici <br />_ Rclriperahon <br />_._ Woodstove <br />Oiher <br />__ CITV OF EVERE IT LOCAL SALFS TAX CODE IS JIUS <br />� � i����eby r.enh�y Ihnl I �av� �eqi nnd?rimmed ihis oppM1caPc� �n I�rn�,v Ihe srime to be hce �nd correct All pravislons ol IdYis end <br />"�'.:�nacrs qev?m�nq Ih�; �qp� o' w0�k will be i�o����phed wi0i whp�Pw spec�hca herein �r POL fhn 9ranUng 0� a pCrrnil Aoes nol pre9ume <br />',• nrvC a��hcnty !u �iol,ile ar canr,�l Ihe pievisiUn ol any o!hei staie rn I�e;il I�w �equlil�ng rnnsiruc'ior. or the parlormanco ol <br />-onslruction ih�tl I am nulhoneed by Il�.v uwner o' Ihi^ pru{;eity lo perloim ��ir wnrh lor �vhic�i ;ipphcahon �s maAe and I comply �vith R�e <br />11�i1rt Cunlr.lClois L�w �8 '_'7 HCW �nd ?96200 IVAC. <br />� • <br />��� i' <br />......._....__,.�� .~.'__'�� U�}�. 2�.0�-: I <br />� y�•.,�"4==N5t'Ac � • I riC� - <br />� _ <br />