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SITE ADDRE93 <br />1� <br />P�RMIT APPLICATIOri <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, �A�A 98?01 <br />��25-257-8810 — FAX 425-257-8857 — www.evere;iwa.org <br />PPPLICATIONS ARE ACCEPTED FROM B AM T� � 4 PM <br />BLOCK <br />PARCEL TAX I.D. p <br />PERMIT M <br />�0�03 -•oo� <br />TENANTNAME CONTACTFORPERMIT PHONE <br />�k'Jb �i�-�.v �'?S�f� �� y� <br />CONTRACTOR p fC� ,S'/ i �� A� o.�ISQPaCI� A�t � �l,�Svi�P Py� =oZ�p� �, �O <br />CONTR. LICENSE p A� Sy Q� �" � 5 b L G µ� v�70 <br />USE OF BUILDING <br />��i't � A�•. <br />NORK DESCRIPTION <br />NO. I TYPE OF FU(TURE OR ITEM <br />Toll�l <br />DathWh <br />L.avatory (wasli basin) <br />Showm <br />Kltclmn sink 6 disposel <br />Dishwashor <br />Clollios washc+r <br />Wator heator <br />Slnk (sorvlcaNar/moplolc.) <br />Dar.kOow provonter <br />Uriral <br />Ddnldng Fountaln <br />Flaor draln <br />Gr�asetrap <br />Root drains <br />Olher <br />HEATSOURCE <br />EleclAc � Gas _ Othar <br />CONTRACT PRICE OF WORK <br />� ��DO <br />�5� �3� <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC - eir handling units <br />�Forced air syslems <br />Gas piping <br />Waler honfor <br />� Gas fireplaco <br />Gas rango <br />Clolhes dryar <br />Rango hood <br />Exheust(an <br />Heatpump <br />U ilt haetor <br />Boller <br />Refrlgerellon <br />Woodstova <br />CITY OF EVERETT LOCAL SALES TA% CODE IS J103 <br />I hereby corili(y that I have resrt and examined Ihls application nnd know the samo to be true and correcl. All prov�slons of lews end <br />oidinecos governing Ihis type cf work, w;ll be complled with whsiher specified heroin or not. The granting ol e permlt does not presune <br />lo givo authonty to violate or can��+l lhe provision o( eny olher elate or local law regulating coneWcflon or lhe peAormance ol <br />construc�ion. That 1 am euthori�ed by tho ownar of lhis property to perlorm tha work lor which eppllceUon is mede and I comply wfth the <br />Staie C c �s�aw 10.27 RCW �end ? °° WAC. <br />�'�'c���/ '%'��OC� �'�/�0 % <br />'IL <br />