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SITE ADDRESS <br />LOT NO. <br />( <br />RMIT APPLICATIbN <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 8 AM TO 4 PM <br />�D� <br />BLOCK <br />PARCEL TAX I.D. A� <br />TRACT OR SUBDIVISION K <br />�Ar W oo� po c.�na5 �'"�/' �(21y u� c,�.� v� u,� S� �f'�z01 425 35o i9Zl <br />TENANTNAME CONTACTFORPERMIT PHONE <br />E�MAIL <br />7" /�e PL.�v►�be�' S7�'1 Palu.�';h�eho a��pJ �0�94�93G�� <br />CONTR. LICENSE p n L�m b L,� � 5 � c 3 Z/2.3%09 <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposai <br />Dishwashcr <br />Clolhes washer <br />Water healer <br />Sink (service/badmop/elc.) <br />Backllow preventer <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Othar <br />HEATSOURCE <br />_Electric �Gas <br />CONTRACT PRICE OF WORK <br />Other �5 0 o+r� x <br />NO. I TYPE OF FIXTURE 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 />Clolhes dryer <br />�angehood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boilor <br />Refrigeralion <br />Woodstove <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 5105 <br />I hereby ceritify that I have read aad examined this appiication and know the same to be true and correcL All provisions ot laws and <br />ordinaces goveming this type of work will be complied wilh whether specified herein or not The granting of a pertnit does not presume <br />lo give authoriry to violate or cancel lhe provision of any other state or local law regu�aling construction or lhe performance of <br />conslruction. That I am authorized by the owner of this property to perform tho work (or which application is made and I comply with the <br />Stale,(%olractors Law 1827 RCW and 296.200 WAC. <br />—S1111`Q — <br />