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P�rtMIT APPLICATICj��I <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98�01 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM t AM TO 4 PM - DEBIT 8 CREDIT CAROS ARE NOT ACCEPTED <br />SITE ADDRE93 <br />LOT N0. <br />✓��= � / <br />lLOCK � TIIACT ' <br />PARCEL TAX I.D. N <br />PERMIT / <br />TENANT NAME I CONTAC7 FOR PERMR - • R101! <br />���� W w�. D 5,,� ; t H 3 � o vs �-t 4, � s <br />conrn�cTort �oonEsa cmrav r� <br />CONTR. LICENEE � <br />USE OF BUILDING ,s I� <br />R�s �d�..,{ «�I <br />M Il�( � FIEAT SOURCE <br />�Electric _ Ges _ Other <br />CONTRACT PRN:E OF WOIlK <br />� SO�000 <br />WORK DE3CRIPTION A� cQ DQc l2 , Nt od �{ �� �,��,.-,t- (�a v�c l,� N�w �i��4a�c <br />STA{�QS� GOr�.Vd�1 P�RTion/ o�` E�ci57i,c/G gE/>K�nh To 8A7N�oon A,�O TiIE <br />Q.�.SZ /N-fo a c�aSE'T NEW Fi-vM81�, rt�fW�v.c4� awn S/�,EE7Koc.K. <br />NO. I TYPE OF FlXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (waah basin) <br />Shower <br />IOtchen sink 3 dispoaal <br />Diehweaher <br />Cbthea washar <br />Laundry tray <br />Sink (aervice/baNmopletc.) <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />Fbor drain <br />Grease trap <br />Roof drains <br />Other <br />� <br />TYPE OF FIX7URE OR REM <br />ac - ak nend�m� �nws <br />Forced Wr systans <br />� ��9 <br />Wabr hsater <br />Gas flroplaes <br />Gas ra�pe <br />Cbthas dryer <br />Rarqe hood <br />E�awt fan <br />Hsat pump <br />unn ne.ter <br />BoINi <br />Reiriperetlon <br />Woodatove <br />Olher <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS �108 <br />I hereF,y ceriify that I have read and e�mined this appliptlon and know the aams to betrw and correcf. AII proNsbns of I� and <br />ord' �aces govaming this type of work will be complied with whether specifled haroin or not The yrantlrq o( a pemrt dost rat pmums <br />h_ give authority to v(olate or cancel Me proviaion of any othx state or local law rspulatlnp conatru�,tiion or ths peRortnrros of <br />constructlon. That I am authorized by the owner of this propeRy W perform ths work for whieh applicaticn �s mads and I comply wHh ths <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />�,( l 4��- -.� � I o/ /� b� <br />SigneTirre oTd-wn !�o n u anz eM ate IIL <br />