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P[VGGGA�� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM w <br />SREMONE55 <br />SITE ADDRESS <br />TAX <br />PARCEL TAX I.D. N <br />PEflMIiY 0�1�� <br />PERMIT i �U <br />,,,PARCEL <br />a-� <br />CS <br />ie wrxo <br />LEGA LOT NO. <br />DESC. I�� <br />oesc. 1a 11�2 <br />amcx <br />BLOCK <br />to <br />weer <br />FTR�ACT p� I <br />Ql,)%� Dt-� r'\VY 11� vita Y� % rl0 <br />QuP.a 75e <br />owxen eoo�ss arvrz�r r <br />OWNER ADDRESS CITY2IP PHONE <br />�c+ 4fdlSto�C- 48203 _ <br />TENANT NAME <br />TENANT NAME <br />Cp1i4Ci FOR PERMIT PHONE <br />CONTACT FOR PERMIT PHONE <br />� <br />� <br />I <br />I <br />CONTRACTOR 4DUPE56 CITY/ZIP PHONE <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />CONTR. LICENSEY <br />CONTR. LICENSE M <br />V <br />� <br />USE OF 8 DING <br />USE OF�BJ/U}DING <br />HEATSOURCE <br />HEAT SOURCE <br />CONTRACT PRICE OF WORN <br />CONTRACT PRICE OF WORK <br />�ry � <br />EIetl�S Gas Other <br />_Electric Gas _Other <br />Sj i1 (� � � <br />•>�1 GDP <br />WORE DESCRIPTION <br />WORK DESCRIPTION <br />PLUMBING <br />PLUMBING <br />MECHANICAL <br />MECHANICAL <br />xo nee os FIXTURE OR rtex <br />NO. TYPE OF FIXTURE OR ITEM <br />xo TYPE OF nxrvae oa �u <br />NO. TYPE OF FIXTURE OR ITEM <br />I <br />I <br />*oaci <br />Toilet <br />ac-anna�mma ����: <br />A/C —air handling units <br />I <br />B.i'tM1lub <br />Bathtub <br />_Forced <br />Fa�c¢E air systems <br />air systems <br />�f. <br />9.� <br />Lavalwy�waA�basin� <br />Lavatory (wash basin) <br />_Gas <br />Gas 0�P�9 <br />piping <br />{ <br />� <br />Shower <br />disposal <br />8 disposal <br />[� <br />� <br />Water healer <br />Gas irepabro <br />Gas fireplace <br />Kitchen sink sinMd <br />Kitchen sink <br />Dishwasher <br />Dishwasher <br />Gas rage <br />Gas range <br />Clothes washer <br />Clothes washer <br />— <br />Clothes dryer <br />Clothes dryer <br />� <br />I � <br />wain, n�ao. <br />Water healer <br />Range mra <br />Range hood <br />�..� <br />Sink (senitt4A rlmo�Melv.) <br />Sink (service/barhnop/etc.) <br />= <br />= <br />Exhaust tan <br />Exhaust fan if <br />_ <br />�xkllaw rycecnm� <br />BackOow prevunlor <br />Neal pump <br />Heat pump <br />Urinal <br />Urinal <br />Unit heater <br />Unit heater <br />OtlnFin9 Fountain <br />Drinking Fountain <br />baler <br />Boiler �I <br />_ <br />Floor <br />Floor drain <br />Refrigeration <br />Rafrigeralion <br />_ <br />Grease trap <br />Grease trap <br />WoWsbve <br />Woodslove <br />_ <br />Pool Grains <br />Roof drains <br />GIMr <br />Other <br />Oilm� <br />Other <br />LILY OF EVERETT LOCK SALES TAX CODE IS NOf <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I M1prOby ceM�lly Iluil I Iuvp �oa0 and examined this dryMira�'um and know the same to be true B�tl COnBtI. NI provisions of IfiK dM <br />I hereby ceritify that I have read and examined Ihis application and know the same to be true and correct All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />oNinaces governing this type of work will be complied with vTe�!im [pecA1BE herein or not. The granting ala permit does not presume <br />to give authority to cancel the provision other dale or brat law regulating construction o� Ilie pe�lu�T&Itt of <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That l am authorized AV Il�c owner this p�op�.itylo perform IM1e work lalwM1lc� application I6 made and I comply with II'9 <br />construction. That I am authorized by the owner of this propr.rty to pertorm the work for which application is made and I comply with the <br />State Contractors LY �E P3G �IIO WAC. <br />State Contractors Law 1 nd 296.200 WAC. <br />sg��rymy .��ncoimaaonmm�o�:ea no=m mm i <br />Signalp�e q�f dwner/Contractor/Authorized Agent Date { <br />(/ �Z <br />f <br />P,tRMIT APPLICATION <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 FROM BAM TO <br />0 <br />