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SITE ADORESS <br />7� <br />LEGA LOT N0. <br />DESC. <br />—� <br />ocRMIT APPLICATION <br />CITY C�F EVERETT PERMIT SERVICES <br />32G' CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� � <br />BIOCK <br />q-� W �wn,,�.� : a�'Z <br />TENANT NAME <br />QIh1 <br />CONTR. UCENSEI! ��/�f � (,�Gj `3�j�I� <br />USE OF BUILDING <br />PARCEL TAX I.D. I� <br />TRACT OR SUBDMSION / <br />ADORESS <br />s (,52� y�a,�u.� <br />ICONTACT POR PERMIT <br />1�2N../Dohi ii4�� <br />PERMIT � <br />� <br />s} �S �lo"l -CioU <br />PHONE ,(�S - Zq'3 • 3 �.'l <O <br />nVun,=ao � �•...^. <br />�7/S� t�3`� AvG 9E 5�/6fl�Wusy <br />+ H6�T SOURCE � <br />Electric _ Ges _ Other <br />WORK DESCRIPTION <br />!l-DD �'ft aJi4t. ✓!n EZ-z s1.� � n/ 6 <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kilcher sink & disposel <br />Dishwesher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other <br />4zS- te3 -3�e7�i <br />GVPIiI�wv� 1'RII�CVrnVRI� <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — eir handling unita <br />Forced air syslema <br />Gas piping <br />Water heater <br />Gas fireplace <br />Ges range <br />Clothes dryer <br />Range hood <br />Exheust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />C�TY OF EVERETT LOCAL SALES TAX CODE IS J706 <br />I hereby certify that I have read and examined this application end know the same to be true end correcl• All proWsiona oi laws and <br />ordinances goveming this rype of work will be complied with whether specified herein or not. The arentlng oi e pertnit doea not presume <br />to give authoriry to vio,ate or cancel the provisfon of any other state or local �aw reguleting const�uctlon or the pettortnance o( <br />construction. Thet I am authorized b the owner of this property to perform the work for which applicaHon ia mede and I oomply with the <br />State Contractors Latv 18.27 and 296.20 _ /O/7/ b <br />( IZ <br />