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PtRIVpIT APPLIGATI(�N <br /> CITY OF EVFRETT PERMIT SERVICES � ....�-3--oJ <br /> 3200 CEDAF2 STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br /> _ APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P �"f�— <br /> . �ii <br /> SITE ADDRESS PARCEL TA7( I.D.# PERMIT q <br /> SL")_ E C�Si,vu �r/ 31 �� v �a - a48 <br /> L[GAL LOT NO. BLOCK TRACT OR SIIBDIVISION k <br /> ��� _ <br /> WN[R ADDRFSS CITV2IP PHONE <br /> J-1�t�lc �.�b M� __Z36_Sz=���'� i�1 ���e32 '206 _ <br /> TENANT NAME CONTACT FrJR PERMIT PHONE <br /> E-MAIL <br /> --caAr�d�b�� -� � - -Ati6R€ss —�IFv��bR�— <br /> �•( �i=- ,Q��=-;-- - !� 2.�'� 8 )6 -096 <br /> CONTR LICENSE p <br /> USE OF BUILOING I NEAT SOURCE CONTRACT PRICE OF WORK <br /> � ___IJcclnc ___C:;�s _ Olhor <br /> _.__ —___ . . .. . _...._- ____.__——__—_--_.____----___--__ <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPC OF FI%TURE OR ITEM N0. TYPE OF FIXTUPE OR ITEfA <br /> � _ Toilet __ A�C - air handlin�unils <br /> f�_ f3a�htub _ Porr.ed air syslems <br /> �O Lavalnry(wnsh basin) __ Gas piping <br /> Shower Walor heater <br /> � Kilch�m sink 8 disposal _ Gas fireplaco <br /> � Oishwashcr __ Gns ran,�e <br /> Clothr.s wnsher Clolhes dryer <br /> lVater healur _ Ranye hood <br /> ._ Sink(scrvicc/badmop�nlc J EXhausl fan <br /> _ Oackflow provenler Heal pump <br /> Urinal Unit healer <br /> Drinkiny Founlain Boilar <br /> _ Floor Arain _ Re�ri�eretion <br /> _ Grnase irap Woodsluve <br /> � Roo(drains Other <br /> ._— Other — ---� <br /> CITV OF EVERETT LOCAL SALES TA%COOE IS J105 <br /> I hrn�by r��nldq th;d I have re, 1 enA r.xamui�A this appGcalion and know lhe same lo be true and wrrecl All provisions ol laws and I <br /> urdm.n.��s q���,rrning Ihls type ol worM,will br,complied with whether speciliod heroin or noL The gianling ol a permit does no�preswne j <br /> tu gi��n:udh��nty 1u �iolato or cancel Ihe provision of any olher state or local law regulaling conslruclion or lhe pertormance of , <br /> cunstruchnn 1 hat I :im:wthnrized by Ihe owner of Ihis property to pcilorm tho work lor whir,h application Is made and I comply with ihe <br /> Stnte Conhadurs _ruv 1H.77 RCW and 296200 W�C. <br /> Siqna u u�� � � n�ndractur�tliu�irr.d Aqrnl �-�- ----� � �Dato �. <br /> ... - - _ —.. i <br />