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SITE ADDRESS <br />111 � � r� n �'�T' <br />IEGA LOTNO. I <br />OESC I <br />TENANT NAM11E <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425 257 8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FFiOM 8 AM TO 4 PM <br />PARCEL TAX 1.0. p <br />i rJP, �-q 051 �� t5 Z � <br />BLOCK TRACT OR SUBDIVISION # <br />CONTACT FOR PERMIT <br />PHONE <br />�p <br />fl <br />CO��6L('�Iti ��J���� E•MAIL I� <br />TOR ADDRESS CITY/ZIP PHONE j <br />Ame.�IG�'n NI6G�c?n�G�� �6r�'. P.0.,80",r /�-��G Mdn�vC� �JA Q�7r71. � <br />CONTR. LICENSE # � _ _ _ , _ _ _ _ „ _ � � <br />USE OF BUILDING <br />HEAT SOURCE <br />Eiedric _ Gas _ Other <br />2�(� y�o7%�% <br />CONTRACT PRICE OF WORK <br />p� +� �'l �.6� <br />WORK DESCRIPTION �' � � y �O!/��^h SC�!`�/ � G PrS O.Y D;�s ,�)8a��"r`T�'r'�� <br />l� �-',��lG�� �,'n,L� �� au��,i`�e No�.,b,�6� <br />N0. <br />PLUMBING <br />TYPE OF FIXTURE OR ITEA7 <br />TOilei <br />Bathlub <br />Lavalory (wash ba5in) <br />Shower <br />Kilchen s�nk S disposal <br />D�shwasher <br />Clolhes washer <br />Water heatcr <br />S�nh (serviceib0rlmOp�etc.) <br />8ackllow preventer <br />Urinal <br />Drinkmg FOunlBin <br />Floor dmin <br />Greaselrap <br />Rool tlra�ns / <br />Olhcr 6S i_��L� _ <br />NO. <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />A/C - art h8ndling umis <br />Forced air systems <br />6as piping <br />waler heater <br />Gas hreplace <br />Gd5 rangc <br />Clolhes dryei <br />Rarge hood <br />E.haust tan <br />Hcat pump <br />Untl heater <br />BoJer <br />Refr�geration <br />Woodstovc <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9705 <br />I hereby cerddy Ihat I have read and ecammed Ihis application and know the same lo be true an�! correct Ail provisions ot laws and <br />ordinaces govermng this type ol work wlll be comptred wdh wheiher specfied herem or no1. The gr�nling of a perm�i does not presume <br />to grve authoriry to violate or cancel tl�e provis�on ot any othei state or local iaw reguialing constructirn or the pedormance ol <br />consiructlon. Th I am auUiorized by the owner of Ihis property to pertorm the •rvork for �vhich applicaUin is made and I comply wdh Ine <br />Stale Comra t s a��1 27 RC�N anU 296200 WAC <br />/ l/,��" i� �� <br />Sinna� re n Owner/L�IratlodAulhOnzetl Aaenl Date <br />