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SITE ADDRESS <br />% % / <br />LOT NO. <br />P�RMIT APPLICATIG��I <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 FROM 6 AM TO 4 PM <br />BLOCK I TRACT <br />PARCEL TAX I.D. N <br />�A,e�SA2A �CoE��E2 /9i7 /�/�H�An�o A✓e. ,Ed,c,% 425',23'2,38`0 <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />�h/KE /hA<ay 5`.1S��;Q-/�S`� <br />CONTRACTOR �A �Q r CO/�(S%%'..(1 C J%¢�j �DRESS CITY2IP <br />/S`.3�i ,?�' nl, w, Msr�. 9�1 �� <br />CONTR. UCENSE N� n� �C, , a.7 7� <br />i� <br />USE OF BUILDING <br />s , F. �Fsio� c� <br />WORK DESCRIPTION <br />HEATSOURCE <br />_ Electric � Gas _ Other <br />PHONE <br />36o-G;2,7zzZ <br />CONTRACT PRICE OF WORK <br />i2, z�a = <br />IO �EF�,�C�' FKiST/ni� FasTr�.B,p9,�, FaU�o�aT�-J <br />�� iry ��JE�,J C'Cl �1 �. F'Q (1n1 ��977cJ�J ,o� ,o�,��/ <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />:� <br />TYPE OF FDCTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this applicadon and know the same to be true and correct. All provisfons of laws and <br />ordinaces governing this type of work will be complied with whelher specified herein or not. The granting of a pertnit does not presume <br />to give authority to violate or cancel the provi: ion of any olher state or local law regulating construclion or the performance of <br />construction. That I am authorized by lhe owner of this property to perform the work for which applicalion is made and I camply with the <br />State Contractors Law 18.27 RCW and 296.200 4'JAC. <br />ii- �:� • a <br />��2 <br />