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F��RMIT Ai'PLICATII..V ! <br />CITY OF EVERETT PERMIT SERVICES <br />SZ00 C[DAR STREET, EVERETT, WA 98201 <br />q�5_257-8810 - FAX 425-257-8857 - W`�✓vr.everettwa.org <br />/ , � <br />,.�� /% APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM __ �O_ ��_� _ <br />� n __ - _ _ _- <br />-�--- PERMIT # <br />- _ �CC 3 P3RjcE 4T�x i �o���A- <br />SITE ��D,�DRE55 _ � i /� �! �/lC� � O� <br />Ni/,��'' j j"1'� � I �� l:-t��3��L'� �? ���?s �--- <br />' 1" ^-'� �-_- TRACT OR SUBDIVISION N <br />I [13P� LOT NO. BLOCK <br />q i� �u��r ��a„� tr��rs n i �� <br />UI.SC ��h,�– �U� _ CIl'fIZIP PHONE <br />J--- nooaess , Sr� �t C>U�t<�'1T 41c=1]�, ?i`�;4 <br />owr+eR ��vvlJzc,J J'���+N S T8 N �. :;�, '1� P, J nl/1 <br />P/A ��')L % <br />li..�� �%�%�-1'V �- i- �t�. � V c.'1U t t-� --- —___ rt�oNe <br />CONTACT FOH PERMIT I���? t� ;) 9� <br />TENANTNAME '-� � : -� . • �I.� ��,y �)����� <br />��)'Y�EI't��;�% ✓[��)�!�:�.i�., EMAIL L� I I� V I'�S <br />_ -----'— A-6DRE55 –.. - - - . .. ---� CITYIZIP PAbA _ cwi <br />�CONTRACTOR �J �pn/ <br />r�v <br />CONTR. LICENSE H <br />USE OF �UILDING <br />����1 V�l'���`�v-- - <br />WORK DESCRIPTION <br />(�7\1 �, � ,�,��' ��t'.Z� <br />------ PLUMBING <br />I N0. <br />HEATSOURCE <br />� [ledric _ Gas _ Other <br />�v ����vU��,� <br />TYPE OF FI%iUR[ OR ITEM <br />Toilet <br />l3a�hlub <br />Lava�ory (�vash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Waten c�ater <br />Sink (scrvicelbadmoplMc.1 <br />E3ackllo�v prevenler <br />Urinal <br />Drinking Founlain <br />Ploor drain <br />Greasc Irap <br />Roo( drains <br />Other __ — <br />NO. <br />I CONTRACT PRICE OF WORK <br />Cs- � ' '�.� <br />�C _ �;�. ,i�- _-- <br />-- <br />- "-- MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />A/C – air handliny unils <br />1=orced air syslems <br />Gas piping <br />�Nater healer <br />Gas tirepl<ice <br />Gas range <br />Clothes drler <br />Ran9e hocd <br />Fxhausl fan <br />He:it pump <br />Unit healcr <br />Ooiler <br />Refrigcration <br />Woodslave <br />Other__ --� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 _ i <br />I here�y certify thal I have rr,ad and examined Ihis applicalion anA kno�v the s�me to be true and correct. All provisions o( laws and <br />t yrve,authonty tolviola�le orlcar�icel the,piovision ollany`other state or loca'I I vi'�regul�aling cor str ul on o91he3p�eriormance ol t��resume �i <br />conslrudion. Thal I am nuthorizecl by the ovmer o� t�iis proper�y lo perform ihe woik for wl�kh application is made and I ccmply wilh Uie <br />State Conl�a rs Law 18 27 HCW :���d 96 200 WAC. i <br />i I <br />�1, % -_L� --- ���;3"� - � <br />Slgna ure o ner�Contrar,IodAu wiized Agenl � L I <br />I <br />� <br />