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05/10/2012 21:25 <br />SITE ADDRESS <br />3�6 ti1R ��� <br />TENANTNAME <br />11SE OF <br />F��^R":II�l�' .APPL(G�QTI�N� <br />CITY OF EVERETT PERMIT SERVICES <br />320a�EDAf�S1'REET, EVERETT,: WA 98201� <br />425-25Z=8810 = FAX 425-257-8857 — www.everettwa.org <br />I <br />APPLICATIONS ARE ACCEPTEp FROM B.AM 70 4 pM <br />. . � PARCEL 7AX LG.1�. . . <br />@ <br />� vy6 �f� <br />TRACT OR BUBCMSICN li: • . . <br />AD RES$ <br />:i <br />CONTACT FOR PERAIIT <br />Cf//a,�v:.r„�i7�. �n/ 7(,'i�� G�G,�i <br />._ ,... '1 <br />��/y �' Z- -: :..._._.__. ���221r <br />' HEAT SOURCE. , ; , , <br />:_ _ '�1'�,�,� ElecVio _ Gas _, Otfler . . . <br />m <br />0006B P.002/002 <br />—�� `.�� <br />71T 8 <br />`fz>`�-3/7— 9ia <br />���- yz} - 3/7-�io <br />CON7RACT PRICE OF WORK <br />S'Do_`" <br />WORKDESCWPTION =•"`'� " <br />.,. <br />%�P /oGtc. �. � jTGc�Qo�a ; .I ; : . : : �.. .... . <br />� .. �I...Vi�i.: Y.' . :_f ii... • . '.f:'�'.Uii�,�l{��I:��1 •r .i ... . <br />. .. ..._....�..._..... . �. . � ..... �. ..�.... .,.. . <br />PLUMBING .. . .. : MECHANICAL <br />N0. I TYpE OF FIXTURE OR I7EM__-_ N0� I :..:........... ..�'ypE OF FIXTLRE OR ITEM <br />1 -- - <br />Toilet � <br />6athlub - .....1. <br />Lavatory (wash basin) � <br />Shower <br />Kitchsn sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water Aeeter <br />Sink (service/badmopletc.) <br />6ackflow preventer <br />Urinal � <br />Drinking Fountain <br />Floor drain <br />rrease trap <br />Roof drains <br />O�her <br />A!G–alrhalidling units <br />forced aIr systems <br />Gas pipi� <br />Wataf I�eatsr <br />Gas fireplace <br />Gas ran�e <br />Cbihea dryer <br />Ranpa ho6d ��. <br />E�aust fan <br />Heat pump <br />UnR heater� <br />9oiler . <br />RefriOeratlon <br />Woodstove • <br />Othaf <br />CITY OF EV�RETT LOCAL SALES TAl( CODE IS 7105 <br />I herehy ceri6fy that 1 have rea4 and examined thfe appliaGon and krww the sama to Ae true antl cortect All provisions o( laws and <br />ordinaces 8ovaming this type of work will he complied with whetherspaClfled herein or ra�:The yranGng.ot a parmit doas not presumo <br />to give authority ro violate or cancel tha provisbn of any athx aWW or lo�l law fepulating mnstruction or 1h� periormance of <br />constructian.'�'hat I am authorizad by the ownar o( this property to pertprtn Vie �ypric for whkh appllcatbn Is mads and I comply witb the <br />State ConUacta Le 18.27 and 298.2QQ16�AC__. i j <br />�/] <br />��� �.�• `��" � //y� ✓ � ., <br />Sianal��of (TvneNConi�aet'�Authonzed enn 1�— � . Oatw � .. <br />