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� �ERMIT APPLIGATIOt� � <br /> � CITY OF EVERETT PERMIT SERVICES i <br /> 3200 CEDAR STREET. E'JERETT, WA 98201 J`' ^ 3'-�9 ! <br /> 425-257-8810-FAX 4`L5-257-SB57-WWW.BVBrettw2.Ofg ���/ _�J I <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � <br /> SRE ADDRESS PARCEL TAX I.D.b PEp`i,x i�X7 <br /> fC7 ! ! 0 EvC-'�G�2�.`�+'• w�t`� I 'Z�iOyZ �IGUZc�O�OU � J y0�� ,t <br /> L[G.4� LOT NO. BLOCK ( TRACT OR SUBDIVISION N – I <br /> OE9C. I <br /> OWNER AOORESS CITY21° PFNJ!!E i <br /> � dv£ SE /SSal�U.iFf � 1n�A <br /> �r�.t,-c.n-cv Grr N-c�tc-.� Cc:Oa 4zio /�v qg,o�� <br /> TENANTNAIAE I CONTACTFORPERMR PHONE ZC�C 7bl z3�y � <br /> � [—. PI cC—ni'Z—� I e.Ma� <br /> ICO flA TO R 2 <br /> i r.1�N SIC.� Fr' fa-�.+nfltieC, I�GOG v�1l.�n PLS �sa-77LE wff � '� �°� I <br /> co►rra.�ice►�se x <br /> �iG-=U�•r Sb'A 93(.- L:L �C. . 7loZ . 23i4 <br /> � USE UF SUILUING � IIEA1 SUUHCh � CUNf HAC( VHIf:E OF WOHK <br /> GGMMC-CQ'a�L - �r'7�C-�S Elec�ric _Gas_Other �7rJ� �� '� <br /> I ------------ -�----------- —� .. I. . _------------- � <br /> � WURK DESCRIPTION � <br /> JNSv'�}�L O1�[C-' US� O Sllrn� O!�( '� 13lYLO�n1l- �+51C/4 <br /> � PLUMBING MECNANICAL I <br /> � NO. I TVPE OF Fl%TURE OR ITEM � N0. ( TVPE OF FlXTURE OR REM I <br /> -�Toile! ���-_ A/C–airhancHinc�unils <br /> i – uatntuo Forcaya�rsystams <br /> Lavalory(wash basin) Gas piping <br /> —� Shower _I Walei heater I <br /> — vi.�..�..�in::P.di��.�_i r��r.;����� <br /> f Dishwashar Gas rango <br /> I _I Clothes washer I =� Clolhes dryer <br /> Water heater Range hoal <br /> I — ;,ink�tsrv�cw'bar,mops�c./ I Cxnaust rnn <br /> _I Backllow preventer =I Heat pump <br /> Unnal Unit heater <br /> n.,����r,i-^un!:::r. �x��i.,, I <br /> Floor drain Relrigeralion <br /> Grea;e Irap � Woodstove <br /> � _ _� Root drain; l I �lher _ <br /> i �' vinet------- I �( _-------- <br /> I <br /> � CITY OF E`JERE7T I.00AL SALES TAX COOE IS 31D5 I <br /> 1 hereby cerilily that I have read and examined this applicalion and know!he same to be true antl conect. All provisions ot laws and <br /> .^.r.`n:rx.:.✓::rn�ntt t�ic:yt.o n!;..,.rk v.iy h�rry.-�'i<:!�+.ith r:`pLha:r,�r�i�:!h.arpir..-,r n:� ?hp,7ranfir.:�n!3 per.r.'::-cg nr.t r.rpei:ma <br /> + to give authoriry to violaie or cancel the provision of any other state or local law ragulaling construcGon or the per�ormance o( I <br /> Iconstruction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Slaie Conlraclors aw 18.27 RCW and 296.200 WAC. <br /> c' ��d 3�°� � <br /> I Si nature ol Owner/Cont2cloqAuthorized Agent Uate l�L <br /> � I <br />