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SITE ADDRESS <br />LOT NO. <br />r �`. <br />PERi�IIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — �vww.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />�545400C <br />3 ��� -P�6 <br />OWNER ADDRESS c�7Y�z�P Pnunt �ZS <br />J�� D�E��� Ei�r�,AR� Po SoX 123�QI �,�,riKE?'1 WA `�82v6 35q-s��s <br />TENANT NAME CONTACT FOR PEP.MIT PHONE <br />J�- NE���►�.,� �z2s-3s�- s�, a <br />CONTRACTOR ADDRESS CITYfZIP PHONE <br />CONTR. LICENSE # D w�t' � <br />USE OF f3UILDING <br />1;9 <br />HEAT SOURCE <br />Gas Olher <br />CONTI�ACT PRICE OF WORK <br />�T i � C'�O� <br />WORKDESCRIPTION uEW �OUj.IDA�%IDIJ F02 F��VBd MOJS�, R��oc�.zE <br />�001� FK.oh, NouS� l�/7o GARAGE. RE/°LAC� Ki'7�N+�N CAEi�/�'TS <br />NO. � TYPE OF FIXTURE OR ITEM <br />Tailel ���� <br />Bathtub � <br />Lavatory (wash basin) /� �/ <br />Shower j/ <br />Kitchen sink & disposal � <br />Dishwasher � <br />Clothes washer <br />Waler heater <br />Sink (service/6ar/mop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap J <br />Roof drains� � i � <br />Other �-�2�� �"��/'`'.L��'L� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air svslems <br />Gas piping <br />Z Waterhealer <br />Gas tireplace <br />Gasrange <br />� Clolhes dryer <br />Range hood <br />- Exhausl fan J/-�? <br />Heat pump <br />Unit healer <br />8oiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhat I have read and examined lhis application and know lhe same lo be true and correct. All provisions of laws and <br />ordinaces goveming lhis type of work will bo complied wilh whelher speci(ied herein or not The granting of a permil does not presume <br />to give authority to violale or cancel the provision of any other slate or local law regulating construclion or the pedormance of <br />construction. That 1 am authorized by lhe owner of this property to perform lhe work for which application is made and I comply with Ihe <br />Slate Conlra�tql�Law 18.27,RCW and 296.200 WAC. <br />1 <br />�� <br />