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P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />32(]Q CEQAR STREET, EVERETT, WN 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS 1tj 11� ,,,,v�.�q �� I PARCEL TAX I.D. M <br />LE� l01 ^ I 1� I�O�C� -� n T <br />DESC. ot K !ti <br />PERMIT M <br />�+as �4s- a�o� <br />C� � nr�cs +�.�� �\c�. 1 �\ �-1 1-l�n� �nc, c c�, � E.ver }� �q c,�a�y <br />TENANTNAME CONTACTFORPERMI� pHpNE <br />� �-m-�-- I G �nnas P�tt �� 4'a.5-�ti5 ���'� <br />CONTRACTOR �R 1 i(�SSoc ��rc S�ap «� � S� �J'I�-�u PHONE <br />coHrn. ��c�se r A j�'I ti ST. �- �i'� <br />USE OF BUILD�NG <br />r <br />h QS�,S.c_..�C�t <br />�DP `�5�1�. y'a,S -�-1RS Sg,cto5 <br />HEAT SOURCE I CONTRACT PRICE OF WORK <br />� Electric _ Gas _ Other � � a CJ � Ci . <br />WORK DESCRIPTION `h�tc `� V�Qu� pDrU;.,_ c..�CS� Y�II. �_� GG,�D1Q • <br />`] <br />NO. � NPEOFFIXTUREORITEAA <br />Bathtub <br />Levatory (waeh basin) <br />Stwwar <br />KiOchen sink & disposal <br />Dishwaaher <br />Clothos wesher <br />LeurWry tray <br />Sink (xrvixhar/mopletc.) <br />Bxldiow prevenmr <br />Udnal <br />Drinldng Fountain <br />Floor drain <br />Greasa trep <br />Rooi drains <br />Other - -- <br />NO. � TYPEOFFUC7UREORIiEM <br />AIC - air hardling units <br />Forced alr systems <br />Gae pipng <br />Water heabr <br />Ges fireplace <br />Gas wnpa <br />Clothes dryer <br />Range Mod <br />Exhaust fan <br />tlaat pump <br />Unit heaLer <br />Boiler <br />Rehigoratian <br />lM1bodstova <br />Otlier <br />CITY OF EVERETT LOCAL SALES TA% CODE IS �106 <br />I hereby cenMy fhat I have read and ezaminad this applip5on and krrow the same b be Wa and canecL All provieions of laws arxf <br />ordinaces govemi�g this rype ot work will be amplied with whether specified herein or nol Tlie p�airong of e pertntt does not prewme <br />to pive euthority to violaEo or cancel the provision of any other s�Av or local law �egulatinp mrretruction or the parformence of <br />construction. That I am authorized by ihe owner of Mis properry h� peAortn the wvrk lor which appGqtlon ic made and I camply wkh ttre <br />Stele Cont,acton Law 1827 qCW end 296200 WAC. <br />Signatureof ar/ContractodAuthonzedP.geM �te <br />�IL <br />o� <br />