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SITE ADORESS <br />NO. <br />l�T�'���. <br />T[NANTNAME <br />P�RMIT APPLICATION <br />CITY OF EVERETT F'ERMIT SERVICES <br />3200 CEDAR STREET, cVERETT, VJA 9820� <br />425-257-(3810 — FAX 425-257•8857 — www.everetivia.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />��� <br />9LOCN <br />� <br />PARCEL TA% I.D. # <br />�;� ������ ., <br />TRACT <br />CONTACiFORPERMIT <br />�b �r�,r, <br />CONTRACTOR ��-�J' j I�/ /�/{ A' U J I SQ�* CI� �Vr �U <br />CONTR. LICENSE p Ap�{ S 1 �r �- �5 b L G <br />'J ✓.Y <br />USE OF BUILDING <br />��h P /�. <br />WORK �ESCRIPTIC <br />i:[.a <br />PLUMf31NG <br />TVPE OP FlXTURE OR ITEM <br />rouoi <br />oamwi� <br />Lavatory (wash ba�An) <br />Shower <br />Kitchon sink 8 disposal <br />Disliwasher <br />Clolhas wash�r <br />Wator hoaler <br />Sink (service/badmo�n'otr.. � <br />Backflow provoNor <br />Urinal <br />Drinkin� Founta�n <br />Floor draln <br />Groaso Irap <br />Rooi dralns <br />Olher <br />PERMIT IF <br />�r��c � �GC�"� <br />PI!J <br />/_ii�Co�..'.7t �� <br />PHONE <br />�-�'7S �/� �a1 �/� <br />CITYIZIP PHONE <br />mG�S✓i�Q 4?iaZ��' IaZ80 <br />9 �1�0 <br />HEAT SOURCE /CONTRACT PRICE OF WORK <br />—Electrlc � Gas __ (,�nor (' ��/�i/7�7 <br />s� <br />� <br />NO. � TYpE OF FIXTURE OR ITEM <br />I A/C – air handling unils <br />Forcad alr eyslems <br />Gas piping <br />'�Jator hoator <br />Gas firoplaco <br />Gas ranpo <br />Clothas Aryer <br />R�nr�R hnod <br />Exhaus� lan <br />Heal pump <br />Unit hoetai <br />t3oller <br />Refrlge-ellan <br />Woodslove <br />CITV OF EVERETT LOCAL SALES TAIf CODE IS �105 <br />I I�eroby corill(y lhat I have read and examined thls application and know the sama lo be truE end correct. All provislons of laws end <br />ordineces governing lhls lypa of work wlll be compllod wilh whather speci(ied herein oi not. The granting of e permA does nol presume <br />In givo auUiodly lo vinlale or cancol ihe provision of any olher slale or local law regulaling construction or the peAormance of <br />construdion. That I em authorized by the owner of this property lo pedorm lhe work for which eppllcation is mede end I comply with the <br />Stato C c 1E1.27 RCW and 7 6D WAC. <br />� % !� J�/l/� �% <br />/Z <br />