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SITE ADDRESS <br />1 ,� �, - ,s, <br />�r_cn r r+o. <br />[)ESC. ��' � <br />UWNER <br />/��Pf�rd <br />TENANTNAME <br />P�RMIT APPLICATION <br />CITY Or EVERETT PERMIT SERVICES <br />3200 CEL)AR STREE i, EVERF'TT, WA 9t3201 <br />425-257-8810 — FAX 425-257-8857 �- www.everettwa.org <br />APPLIGATION.ri ARF. ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />CONTRACTOR N' f� 5���/4f <br />CONTR. LIC[NS[ p A p.� �� �(� � <br />•,.� «�� <br />USE OF BUILDING <br />� <br />�fi, P /'�.�. <br />NORK DESCRIPTION <br />PLUMBING <br />NO. I TYPE OF FIl(TURE OR ITEM <br />_� <br />Tallol <br />B�lhWb <br />i_evatory (wash basin) <br />Shower <br />I<itchen sink 8 disposal <br />Dishwashcr <br />C�olhes washor <br />Watnr hoaler <br />Sink (sorvlco/barhnop/etc.) <br />Backllow provonlor <br />Urinol <br />Ddnkinp Founlaln <br />Floor drain <br />Groaso hep <br />Rool dralns <br />Olher <br />PARCFL TAX I.D. # <br />'/; c%r, z :,C�/� =1(���c.' <br />TRACT <br />CONTACT FOR PERMIT <br />�b C`��-�rti <br />ADDRESS <br />I u.�l (�P«r� A�r �`B <br />�LG <br />HEATSOURCE <br />_ Eloclric X Gas __ Olhor <br />PERMIT p <br />''c�1U � ��'I <br />PHONE <br />�S�f� ��� <br />CITY2IP PHONE <br />�,.�G�S''il� v����'l��O <br />%�.��o <br />CONTRACT PRICE OF WORK <br />�i�l��� <br />�3 � <br />NO. � TVPE OF FI%TURE OR ITEM <br />NC — air handling unils <br />� orcad alr syslems <br />Gas plping <br />Wutor hoator <br />Gas fiieplace <br />�as rengo <br />Clothes dryer <br />Range hooA <br />Ezhausl lan <br />Heat pump <br />Unit he2tor <br />Boller <br />Relrigerallon <br />Woodstove <br />Olher <br />CIN OF EVGRETT LOCAL SALES TAl( CODE IS 7105 <br />I hereby ceriUty thal I have read end ezamined this applir.ation and know �he samc to ho lrue and co�ect. All provislons af lews end <br />ordinecos governing lhis typo of work will be compliod wilh whelher spec!h,.d hereln or noL The qranting of e permil does no� presume <br />l0 81vo aulhorily lo violate or cancel the provision ol any olhor stale or local lew regulating conslruction or Ihe peAormance ol <br />conslruc�ion. Thal 1 am aulhorized by Ihe ownor ol lhis property lo perlonn lhe work for which applicallon is made and I comply with Ihe <br />Slalo G ctb w 18.27 RC�1' and 0 WAC. <br />�' `�� ����o� <br />Signelure ol OwnoNCoNrar.lor/Aulhonzed Agent Date �, I L <br />