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SITE ADDRESS <br />LOT NO. <br />DESC. <br />P�.RMIT APPLICATI(��� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />PARCEL TAX I.D. k <br />TRACT OR SUBDIVISION N <br />PERMIT N <br />vZs•25g •13�5 <br />�aSun Ash�a�. 4c��5 R�cK-u Avtr 4..cfta w4 9A-zo3 <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />E-MAIL <br />Kq,Lw.F�� 64v�.+:`� 4czS W v�.r�-do�ais.ct 0�• 3Ge•SGg •o�6Z <br />CONTR. LICENSE It <br />kRLr.1� <br />USE OF 9UILDING <br />�e51� t rvc � <br />WORK DESCRIPTION <br />��s(�1� �.�11Q� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposai <br />Dish�vasher <br />Clothes washer <br />Water healer <br />Sink (service/bar/mopletc.) <br />BackFlow preventer <br />Urinal <br />Drinking F.iuntain <br />Fioor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEATSOURCE <br />_ Eleclric _ Ges _ Other <br />S �-o•�-� '�nl S 6R�� <br />N0. I <br />5 �i�g O <br />CONTRACT PRICEQOF WORK <br />L��UQ _� <br />TYPE OF F,XTURE OR ITEM <br />AIC — air handiing units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhausl tan <br />Heat pump <br />Unil healer <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other�� � i. - c�rm,r <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 1105 <br />I hereby certify that I have read and examined Ihis application and know the same to be true and correct. All provisions ot laws and <br />ordinances governing this lype of work will be complied with whether specified herein or not. The granting of e pertnil does not presume <br />to give aulhonty to vidate or cancel the provision af arry other state or local law regulating construction or lhe performance of <br />construction. That I am authorized by the owner of this property ta periorm Ihe work for which application is mede end I comply with the <br />State Conlractors Law 1827 RCW and 296.200 WAC. <br />