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SI7E ADDRESS <br />LEGAL LOT NO. <br />DES0. �� � <br />OWNER <br />�����.a Kj� <br />TENANT NAME <br />;� � <br />� : --;"` <br />CONTR. LICENSE R <br />USE OF BUILDING <br />P�RMIT APPLICATIC;N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wuvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />_, � - <br />BLOCK <br />WORK DESCRIPTION `a j� �� � N �: — <br />PARCEL TAX I.D. # <br />� lo,i`I) �3`b 6C <br />TRACT OR SUBUIVISION N <br />ADDRESS <br />+ 1-1 � C� f N c`� �'t`�E <br />�CONTACT FOR PERMIT <br />� v� / L iUC � <br />� �S�/ ([;�//%T['.;' (,(L/ila <br />I HEATSOURCE <br />� Electric _ Gas _ Other <br />�.,t� 1�E • 5r1nr' - p�:�t= <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kitcli�n sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Waler healer <br />Sink (sorvicc/bar/mopletc.) <br />BackOow preveNer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Othor <br />NO. <br />����� <br />PHONE <br />� O —D <br />ip <br />`sys-�`1s <br />CONTRACT PRICE OF <br />��I �. nnC, rO fl <br />����b�rH, <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gas range <br />Cblhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />Boller <br />Refrigeralion <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby coritify thal i have read and r.xamined this application and know t!�e same to be true and correct. All provisions of laws and <br />ordinaces goveming lhis lype oi work will be complied wilh whelher specifiad herein or noL Tha granfing of a pertnit does not presume <br />to give authonry lo violale or cancel the provision of any other state or local law regulaling construclion or the pedormance of <br />construclion. That I am authorized by lhe owner of this proporty to pedorm lie work for which applicalion is made and I comply wilh the <br />Stale Contraclors Law 18.27 RCW and 296.200 WAC. <br />`- . �-��_' /L`��_(' % <br />ialure o( Ow�odContraclodAuthorized Agent Date ( <br />/� <br />