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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SEI�VICES <br />3200 C[DAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.nrg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TC 4 PM <br />SITE ADDRESS <br />0��3 �'�p� sc- <br />LEGAL LOT NO. BLOCK <br />PARCEL TAX I.D. # <br />7RACT OR SUBOIVISION # <br />C I �% ati /�1 <br />�J��"lii � I�Pi �1G'}�J4� V��3 y ^ I"4 �; <br />TENANTNAME CONTACTFORPERMIT <br />�,�„ .� „ I �'1a�k Qau3cl�- <br />l�t�l� ��SdIUC'{ic>.. �V/OS(.��+NL ly4�5E <br />GONTR. LIC[NSE p mW �`� L(�3 3�f1 <br />USE OF BUILDING <br />F,ii�P( •�'�i <br />�oi�,ell We. �l$Cli <br />HEATSOURCE <br />Eleclric _ Gas _ Olher <br />WORK DESCRIPTION <br />—�i %cor es��� -��d �lwr- + Tub � �.e.+.o�e. �,;le� <br />I(e ,;�- f�S��`IJOrITI <br />PLUMBING <br />NO. I TYPE Of F�XTURE OR ITEM <br />y Toilet <br />X 6athlub <br />Lavalory (wasli basin) <br />Showcr <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (servicelbadmop/elc.) <br />Back(low preveNer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roo( drains <br />Olher _ <br />fi- 1E: <br />PHONE <br />PERMIT # <br />_ ;�i. f 14 - GL'� <br />yas-s�r� <br />_ v�_ - v <br />MAIL /*In/ii/Y.v.i<<,�/��c�i'c- <br />�o(, -47.?- v 9 � 2 <br />�� — <br />CO TRACT PRICE OF WORK <br />� �Mrl �:�fL��6 <br />�tlno�im, " �Dr�e+ <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C – air handling units <br />Forced air syslems <br />Gas piping <br />W aler heater <br />_ Gas lireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhauslfan <br />Heal pump <br />Unil heater <br />Boiler <br />Relrigeralion <br />Woodstove <br />Olher <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili(y thal I have read and examined this applicalion and know Ihe same to be lrue and correcL All provisions ol laws and <br />erdinacns goveming this type o� work will be complied wilh �vhelher specified herein or not. The granting ot a permit does nol presume <br />to give aulhority to violale rr cancel the provision o' any other slale or local law regulaling censlruction or the performance of <br />construclion. That I am authorized by the owner of Ihis propeAy lo pertorm lhe work (or which application is made and I comply wilh Ihe <br />Slal�ontra�lors Law 7�27 RCW and 296.2Q0 WAC. <br />//: �°,: / � /1--� � /0 -C�8 <br />SignaWre of OvmedConlractodAuthorized A�ent Dale <br />