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QERMI� APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, W/1 98201 <br />425 257-8810 - FAX 425-257-4857 - wevw.everettwa.org <br />APPLfCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 6_ a 5-0 <br />SITE ADDRESS PARCEL TAX I.D.1 PEflMR N <br />1 Ao3 7S�-� Sf,SE cp 4�23 �mG03 000 ('�c,����. c� `I_ <br />LLGAL LOT NO. ULOCK TRI.., f Ofl SUBDIVISION R <br />ULSC, <br />OWNER p ADDRESS CIT\iZIP PMONE <br />6:bsok a SANd.�� 5'-�►��►+i 1803 75'�� S�r�r� SE' 98do; CS'�sjSs�-�9yz <br />TEHANT NAME I CONTACT POR PERMR PHONE ('; ( � �j,`,.b :.. S- S`i �.� <br />+vk.•-.+t,., (:�.V�.��3yr�..��� <br />�-M�IL <br />NiNA TSR ADDRL-o .'T��n M <br />CONTA. LICENSF R <br />USE OF 13UILOING <br />�! leAYtsQ <br />WORK DESCRIPTION /y�� �rMs <br />�' <br />��'xao' Fr�.,- _ r�4J <br />Se'�f US� Qu.lt�� a <br />--- oi �u�o�,.in <br />HEAT SOURCE ��j <br />//f <br />ElccVic Gas Othci <br />CONTRACT PRII;E OF WORK <br />Fer Gwv�u Flonc, —f:+L �►//S f Gn�y��� <br />(O�1( zi� 5��6 Oh E9�P�'�-st Oi� 8414'�. <br />� o►t Sl�L 1 S�l+� w�Us <br />NO. I TVPE OF FI%TURF Of7 1TEM <br />Toile� <br />Dalh!u <br />Lavatory (wash basuq <br />Sfrorrei <br />Kitche� sink fl dsposal <br />U�shwa:.har <br />Clolhas wu:.hor <br />Wnlar I�va�or <br />Smk �ServiGebN �mop rl�� 1 <br />Il;ickllaw pieventvr <br />Unnn� <br />I�nnti�nq founi�nn <br />Ilnm d�ain <br />Giea;c tiap <br />Ront drluns <br />Othei <br />NO. I TYPE OF fIXTUHE OR ITEM <br />NC � n hardhnc� uniL: <br />forced air sys�oms <br />Gas q�ing <br />Wntei heatei <br />Gas fiivplace <br />Gas raig�.r <br />Clathes dryer <br />N;�nq�� Ikiod <br />Cxhaust lan <br />Heat pump <br />llnd hea�er <br />Bo�lOr <br />Reingaralion <br />Woodstove <br />ptl�r <br />CITY f� EVERETT LGCAL SALES TA% CODE IS 7105 <br />� i�ereby centily that I Ik�ve read and o■amined this a{�IicnUon o�d krrow Uie same to bo inie arxf corred. All provisions ot laws and <br />rndinaces govemmg tfws type ol work will Ge compliee] with wheRior s�ecihed herein or not. Tha grantirg of a permit tloes ial prt�sume <br />�n ipve autlwnty lo vidate or canc:el Ihe piovlsion ol any uther slalo or local law regulating construciion or Iho pertormance ol <br />� nnstrucUon. Thal I am aidl»rired by the owner ol this pmp[+rty t i F�edorm the work lor which appMcatan is made and I comply Ndh the <br />;trtla Gmtlractor,: Law 18.77 RCW �uxf 296200 WAC. <br />� <br />',�qn,nuro ol n�r o� iactonAutlanzetl Agenl ato <br />r <br />