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SITE ADDRESS <br />LOT NO. <br />5 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-267-8810 — FAX 425-257-885' — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />sos�noonnsr <br />BLOCK TRACT <br />oao D-0� <br />l llo � f'A/Dr Nl t.u/ �NG <br />P MIT/#- <br />�U� ��'�/ <br />3 Sos- ��fg- <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />I �+e•�a,ri �oisel 1�OS-lf'f'�- 341� <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />�Ww.! �S �q '`��/J n q <br />CONTR.LICENSE# /W�„��� �Uv� uo���e✓ �L q�za3 D�S�7`TO' ��1�/ <br />USE OF BUILDING <br />RcSf�a��� I <br />WORK DESCRIPTION <br />Bu���,�y <br />HEAT SOURCE <br />_ Electric � Gas _ Other <br />QNI C115��NrY 6A�a�L INTtl Ir✓Pn�� �[iLPi <br />! <br />NO. � TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothe s washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drein <br />Grease trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />� � 1Q�4 <br />? �.�.:�,' — <br />�.) ��e�0 i 7� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air hantlung 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 />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify thal I have read and examined this applicalion and know the same to be true and wrtecL All provisions of laws and <br />ordinaces goveming this type of work will be complied with whelher specified herein or nol The granting oi a pertnit does not presume <br />lo give authority to violate or cancel the provision of any olher stale or local law regulating conslruclion or Ihe performance ot <br />conslruction. That I am authorized by the owner of ihis property 10 pertorm lhe work for which application is made and I comply with lhe <br />State Contraclors law 18.27 RCW and 296200 WAC. <br />�,�`�. I�/►s/C � <br />z <br />