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From:Iti�AC INC. <br />i Ta:914252578857 O1,/o312011 01:32 r474 P.002I003 <br />� <br />PERMIT APPLICATION <br />Ci7Y OF EVERETT PEFiMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425•257-6810 — FAX 425-257-E857 — www.averettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADURESS <br />�/ 1��.�AeT/ <br />�EGA LOTNO. BLOCK <br />�✓�,�sTT�us�NG %}crt�fa'; <br />TENANTNAME <br />�( � fi' <br />CONTAACTOH ��� !NG <br />corrrFl.uco+se� /M,4e� "�"QQ�BC�j- <br />USE OF BUILDINQ <br />PARCEL TAX I.D. • <br />iAACT OH SUBDIVISION / <br />ADDRESS <br />'y - 27i5 �5�`'.fj <br />PHONE <br />/ - � `�i <br />IfRMITM <br />��/D/- �l <br />ONE <br />�Z5 -303 -i/3 y <br />bAE 3�Q <br />4�L�/-7o� <br />MEAT SOURCE I CONTRACT PRICE OF WORK <br />✓Electric ✓Ges _ Other <br />WORK DESCpIPTION //,yj'�ly�,��, y�) G�+1' �S,rf��r�Ul� ; �U�!/!� ti�G.-.J COP�� <br />��,��s �o a.w r ky-�r'�s �.� ,q,�+�.�v covy oG•s�uPe-o�r' wo.cL.c o��,�a� <br />NO. I TYPE OF FlKILRE OR REM <br />Tollel <br />—i� Bathtub <br />� Lavatory (wash basin) <br />, Shower <br />Kitchen sink B disposal <br />' Dishwasher <br />� Clothes washer <br />�[� Watar heeter <br />Slnk (service�bar/moplolc.) <br />6ackllow preventer <br />� Urinel <br />� Drinking Fountein <br />Floor drein <br />Greaae trep <br />Rool dralns <br />O�her <br />NO. � TYPE OF FIXTUSiE OR REII <br />�vc — etr nanmmg units <br />Forcod alr syslems <br />Gas plpinp <br />Water healer <br />C,as Iireplsce <br />Gas ranpe <br />Clolhos dryer <br />Renpe hood <br />Exheustlan <br />Heat pump <br />Unk heatar <br />Boiler <br />ReMperallon <br />Woodalove <br />ana� <br />CRY OF EVERETT LOCAL SALES TA% CODE IS 9105 <br />I horeby cerllNy Ihat 1 hsve read and examined lhis appllcatlon and know tha eame lo be true end correcl. All provblons ol laws and <br />ordinaces govaminp Ihla rype of wo+k wlll be complled with whelher epacllled hereln ar not. The prantinp ol e pertnil does not presume <br />to give authorlty to vlolete or cancel Ihe provisfon of any other stete or locel law reBulaUnp construction or 1he peAortnance of <br />construction. That I am euthorized by lhe owner of thls property to peAortn the work Ior which applkatlon Is made and I compy with lha <br />Stale Contractors,6ew t$.27ACW end 298.200 WAC. <br />�•3 �.te// <br />