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SITE ADDRESS <br />LOT NO. <br />PEh2Ml� APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRE[T, EVERETT, WA 987_01 <br />425-257-8810 — FAX 425-257-8857 — www.e��erettwa.n-q <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �-7-� —Q7 <br />BLqCK <br />:3�� ► <br />TENANTNAME <br />�?,� i;,,«f I��� klFs _ <br />CONTRACTOR <br />.4.�r5Cn �C:15i. •�ba.0 <br />CONTR. UCENSE K <br />USE OF BUILDING <br />PARCEL TAX I.D. # <br />PERMIT # <br />'—�� /'"�� ���-l0 2_ <br />" I�i" �I.I r .�� <br />CONTACT.�OR PERMIT PHONE <br />i�'l�ke I�c<rs���� ti�-s-3��-�535 <br />ADDRESS CITY2IP PHONE <br />�k I�z e��is Dr. Q-��o�! ���e k,�l ya� - 3� �-.�535 <br />HEATSOURCE <br />_ Electric ,� Gas _ Olher <br />WORK DESCRIPTION L� -(' I� <br />(le�InCt l �)t7 ��,�Cl/1�'I-/ <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />Toilel <br />Dathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 di5posal <br />Dishwasher <br />Clolhes washer <br />\Naler he;.ter <br />Sink (servicelbadmopletc.) <br />Backflow preventer <br />Urina� <br />Drinking Founlain <br />Floor drein <br />Greaso :rap <br />Ronf drains <br />Olher <br />ar�� <br />NU. <br />CGNTRACT PRICE OF WORK <br />�.v0 �J�i• C:� <br />/ <br />Cti�� n��cJ S <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />A/C — air haodling units <br />_ Forced air syslems <br />Gas piping <br />W aler heale� <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />� Exhaustfan <br />Heal pump <br />Unit heater <br />8oiler <br />Reh�geralion <br />Wocdslove <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />I hereby ceritity Iha� I have read and examined Ihis applicalion and know the same to be true and correcL All provisions o( Iar�s and <br />ordinaces goveming ihis type of wurk will be complieA wilh whether specifed herein or noL The granling o( a permi� does not presume <br />to give authonty lo violale or cancel the provision of any other state or local law repulating construction or ihe peAormance of <br />construction. That 1 am eulhorized hy the owner ot this property to pe�forni lhe work for which applicalion is made and I comply wilh lhe <br />State Contractors Law 18.27 R�W and 296 200 WAC. <br />;�%r l _ . � <br />�.:;��G �-�..... �,-a,-��7 <br />Signature of OwnedContractod uthonzed Agent Date �/ <br />Z <br />