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�IIC' j "� �.�� <br />SITE ADDRESS <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3zoo cr_on� srRErr, �vr_r�rTr. wn sazo� <br />425-2��-8810 - FAX A2,-257-885i - www everettwa.org <br />APPLICATIONS �RE ACCEPTED FROM 8 AM TO 4 PM <br />_��'�"w�fl Ic�ce � Pe a�oc PIaC'.L <br />11. G.�1 LOT O. <br />Df 5 . <br />�_ia � � 1X12 D_' � �_ <br />OWNER <br />N���`Jl�i� �1�-D�f1�OF1'TZK. <br />TFNANTNAME <br />N�R' <br />TRACT <br />51 LI <br />� .., <br />i � _ <br />, �� � <br />�_ <br />PARCEL TAx I.D. M PERMIT # � <br />�38-Ooo-n��-oo p��cb� � ;;' . � <br />z„ f}crres 3 <br />nuunens uniar PNONE y2S-dsl-Io110 <br />ip��s �a..o EwE s �� wr� �Qo�z <br />CONTACTFORPERry �T PHONE <br />I,cJ At{ Ue V-�4iar Y�S- (�Sb - 7Y3 $ <br />CONTNACTOR •'r0 $�c DE�%�KM�NG� ADDRESS <br />CONTR. LICENSE R <br />USE OF BUILDING S;u3 le- F�m, �y <br />1 <br />Res�detilia� �o„oo�:,,;w, <br />WORK DESCRIPTION � � <br />'�D CbNST%1-1t�-`� 1 5%A1�oLC <br />. _. _ _ .--- ---- <br />, PLUMBING <br />NO. � TVPE Of Fl%Tl1R[ OR ITEM <br />. J. lailr.�___'— _—_'. . ___ <br />� _ Oa�htub <br />_ �_ Lavatory (wash basm) <br />�_ Shawcr <br />. �_ Kitchen smk 8 disposal <br />_f__ Dishwasher <br />J_ Clolhes washer <br />�-_ Laundry Iray <br />.�_ tiink (servir,eihadmo���etc I <br />[3�,cknow preventer <br />Unnal <br />_ frmking Founlam <br />Fhor drain <br />Grease trap <br />(f_ Rooldreins <br />Olher <br />CITYIZIP PNONE <br />HEAT SOURCE CONTF.ACT PRICE OF WORK <br />� �sr: <br />.__FJer.tnc _✓(;.is__Other ,�I���' a) <br />`?'17n�L�./ ,�Q'flA�lt� A L�OIJDOMi 1,/1�.lri� LI�IJ�"f <br />� <br />� / <br />� MECHAVICAL <br />NO. � TVPE OF FI%Tl1RE •.R ITEM <br />A/C - a�r handlmg imns <br />�Force� air systems <br />Gas pipmg <br />.� Water heater <br />_ L Gas fveplace <br />Gasr.nge <br />Clolhes dryer <br />Range hood <br />_�/ _ F_xhaust fan <br />Heatpump <br />L nit heater <br />Eadcr <br />_L Refugemhon <br />WoodStOve <br />Other <br />CITV Of EVERETT LOCAL SALES TA)( COOE IS �705 <br />I herrby u�nldy �hal I have read and eKamined �his epphwtion and know Ihe same to Ge irue and conea All provisions of laws anA <br />���J�narxs govermng Ihis type ol wurk �+nll be comphed adh whelher speGfied herem or no1 ihe gianung ol a permit does not presume <br />tu qrve au�honty to violate or wnca� Ihe provision ol any olher stale or local law reg�lalmg consirudion or �he perlormance of <br />��onslruy1�on Thal I am authori¢ed by the owner ol th�s property lo oeAorm the work for wluch apphcation is made and I comply vnth the <br />Siale C�(aht[actc is Lpw 19 27 RCW and?96.2Q0 WAC. <br />�/ <br />