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SITE AODRESS <br />20 Fl <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />�uan oc�no <br />TENANT NAME <br />T R pWG <br />CONTR. LICENSE M�^ <br />.rv� <br />USE OF BUILDING <br />PE�MIT APPLICATIO� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 /`� r0 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org (j <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />� <br />BLOCK TRACT OR SUBDIVISION N <br />ADDRESS CITYIZIP <br />t�a�ia �er�ano �� �cm.� <br />ICONTACT FOR PERMIT � <br />HEAT SOURCE <br />,_ Electric _ Gas � Other <br />PERMIT N <br />� t373 <br />CONTRACT PRICE OF WORK <br />r� <br />WORK DESCRIPTION <br />��PQ,r� firt� dawnaa�ec! hornt� to prior aondifion <br />��o,�e �oss, b�rt to bieing a�� rtep�acxmenrs to <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Ciothes washer <br />Water heater <br />Sink (service/barlmop/etc.) <br />Backliow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling u�its <br />Forced air syslems <br />� Gas piping <br />]� Water heater <br />Gas fireplace <br />Gas range <br />�Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeralion <br />Woodslov <br />,� Other� <br />_ �� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br />I hereby certiy that I have read and ezamined this applicalion and know the same to be true and correct. All provisions of laws and <br />ordinances governing ihis type of work will be complied with whelher specified herein or nol. The granting oi a permit dces not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br />construction. Thal I am authorized by the owner of this property to perfortn the work for which application is made and I comply with the <br />Stale Contradors Law 78.27�W and 296.200 WAC� <br />