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SITE ADDRESS <br />I:Ua <br />TENANTI'.ME <br />P�RMIT APPLICATIOrv <br />CITY OF EVFRETT PERMIT SERVICES <br />3200 CEDl,R STREET, EVERETT, WA 90201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM <br />'�� ,� �,�/ �� <br />� 6LOC� TRACT <br />CONTRACTOR �f-� S��/� <br />CONTR. LICENBE p <br />'1SE OF BUILDING <br />� � A <br />WORK DESCRIPTI( <br />g�3S�� ��1 <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />TMI�I <br />Dethlub <br />Levatory (wash basln) <br />Showar <br />Kitchon sink 8 dlsposal <br />Dishwashor <br />Clo�hos washor <br />W ator ht�ator <br />Slnk (servlcel�aNmop/otc.) <br />BackOow provontor <br />Urinal <br />Drinklnp fouMain <br />Floor draln <br />Grnase Ire� <br />Rool Arelns <br />Othor <br />P<,RCEL TAX I.D, p PERMIT M <br />��fvG�i��l��sz C� � s � Cn`/ <br />,�CJO_NTACT FOR PERMIT <br />4-kJb �/%'�sl iv <br />ADDRESS <br />� U.�� aPuC� A✓f �`B <br />'> / G <br />HEATSOURCE <br />_ Elnclric � Gas __ Olhcr <br />.7< <br />PHONE <br />�S�f� �� �/� <br />CITY2IP PHONE <br />mG�s�ilP N�.lb'�'/��O <br />%���o <br />CONTRACT PRICE OF WORK <br />�i �l�»� <br />� �3 � <br />NO. � TVPE OF FI%TURE OR �TEM <br />NC — air handling uNls <br />�� orced alr systems <br />Gas plping <br />Waror hoator <br />� Gas firoplacc <br />Gas rango <br />�Clothes dryer <br />Rango hood <br />[xheustfan <br />Heat pump <br />Unit hoalar <br />Eioller <br />Refrlgeratlon <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAl( CODE 19 7106 <br />I heroby corilify Ihel I have read and examined Ihis appliratan and know the same to be true end correcL All provislons of laws end <br />ordinecos govornln,y lhis typo ol work will tre comphnJ wilh whether specified heroln or not. The granting of e permlt doea not piesuma <br />to give aulhorlly to violate or cancol the provision o1 any olher state or local law reguleting construction or lhe pedormence ot <br />construclion. That I am authorized by lhe owner of Ihis property to pedorm the work for which epptica0on Is made end I comply wilh lhe <br />Sl�to C c 1 D.27 RCW and 9il',VAC. <br />�� 3��/�% <br />Signature�OwnedContraclod/lulhorized Agan� Date I i� <br />