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SITE ADDRESS <br />,- : . , .. <br />LOT NO. <br />DESC. <br />�cRMIT APPLICATII�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, `Ali� 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARC[L TAX I.D. # <br />BLOCK � TRACT OR SUBDIVISION # <br />3 � �'�'Q <br />PERMI' # <br />M o90�-� <br />�i:s. �.50 • «� 4 <br />Av� eta� 5-��0� Skol rr,irvie�.J A�,e �c�e�t 4$2c3 <br />TENANT AME CONTACT FOR PERMIT PHONE <br />Efi1PJL <br />NTRACTOR K���� ���}`�� A DR � P <br />�io2.S W Vheauoc.j �'F-�fl� g�o�>•5G>8-G��o2 <br />CONTR. LICENSE # <br />KR��,E Iri�oCo�Pd 5�,,.,,,,,;��,, - — <br />USE OF6UILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br />WOFiX DESCRIPTION � - ^,ac o a <br />a c'V. <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mnp/etc.) <br />BackFlow preventer <br />Urinal <br />Drinkiny Founlain <br />Fioor drain <br />Grease trap <br />Roof drains <br />Other <br />aG <br />_ rleclric _ Gas �[ Other o� 1 � y SOG. <br />G�. \ TUYhG�1L li�.�• O� ��` nCC..�. <br />NO. I TYPE OF FIXT��RE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Ctothes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this application and know lhe same to ba lrue and correct. Ai'. provisions of laws and <br />ordinaces governing this lype of work will be complied with whelher specified herein or not. The granting o! a permit does not presume <br />lo give aulhorily to violale or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. Tbal I am aulhorized by the owner of lhis property to perform the work for which application is made and I comply with the <br />State Conlractors Law 18.27 RCW and 296.200 WAC. <br />Q. �ti. 1� . (� 3 • �O • U�t <br />