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SITE ADDRESS <br />ir'�1�1 jji <br />LEGAL LOT NO. <br />��_ �,.,,.� I, <br />TENANTNAME <br />PrkMIT APPLICATI(�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />BLOCK <br />�: <br />PARCEL TAX I.D. # <br />TRACT <br />�ERMIT S <br />(�06 -Dl. <br />ADDRESS CITY2IP PHONE <br />�„a ,�I'I 78{� ��a�c Nc il�ara,.n� 9�'1�o y�r 3s� •o•rss <br />CONTACT FOR PERMIT PHONE <br />��) <br />j��.t ��.h0..K. � <br />CONTHACTOR �l.(, .��, �,�c (.�\1H��mr�i �r,.c ADDRESS ,3�?�, :i...n� aY'- CITY2IP <br />v....r 8 [Jc�ett �r7c, <br />CONTR. LICENSE p /� <br />(�'i'f"'��i�l/uL lV- <br />USE OF BUILDING <br />HEATSOURCE <br />_ Eleciric _ Gas <br />.jC.�' doll <br />PHONE <br />`�:25 3•� b-o!'1 <br />CONTFACT PRIGE OF WORK <br />Other ---- '� � C , S'y (, �j . �a <br />WORK DESCRIPTION <br />(�..,.<.� ,� f��..��._P,s �lP.,�.��it �..�� �-..._� c.,c� r�c�...l:n�-y h�-<< i,,.� <br />� <br />�� ,. c. �.. <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />7oil�l <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwashcr <br />Clolhes washer <br />Walor heator <br />Sink (service/badnwp/alc.) <br />Backllow prevanlcr <br />Urinal <br />Drinkinq Feunlain <br />Floor drain <br />Groasr. irap <br />Roof drains <br />Other ___ <br />� <br />MECHANICAL <br />TVPE OF FI%TURE OR ITEM <br />A/C — air handling unils <br />_ Forced air syslems <br />_ Gas pipinc� <br />__ Waterhealer <br />Gas fireplaco <br />Gas rango <br />Cblhos dryer <br />Ranpohood <br />` Exhaust lan <br />_ Heat pump <br />Unit heater <br />Boilor <br />Rolrigeralion <br />Woodstove <br />Other <br />CIT'f Of EVLRETT LOCAL SALES TA% CODE IS 3105 <br />I hereby cerilily Iha� I h:rve read and exainined lhis application and know Uie same lo be Irue and c.rorrect. All provisions of laws and <br />ordinaces governiny Uiis type of work will bo complied wilh whelher specified harein or not The grenling of a pormi� does not presume <br />to give aulhority to viola�e or cancol Ihe provision of any olher stale or local law regulating consituction or ihe perlormance ot <br />conslruclion. That I am aulhorized by Ihe owner o( this properly W porform Ihe work for which application is made and 1 comply wilh the <br />Stalp Contra rs Law 1827 RCW and 29f 200 WAC. <br />�� � V� _�;tl � ��.ti>�� G /3�-/vc� <br />