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SITE ADDRESS <br />Y�OCo <br />LEGAL LOTNO. <br />P�cRMIT APPLICATIt�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APRLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />33�J s� 5� <br />BLOCK TRACT <br />PARCEL TN( I.D. # <br />//�a5 ��a <br />�l I o l� -oo� <br />PERMIT # <br />M I�r/ 'a o/ <br />�n � e o � �zc-�-5z - Q�o� � <br />c� 1\ec p,�,c� 33�� s+ sc =�,-e�c�rc 4�zo� <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />CONTRACTOR Ks,�,,,,��� Ne��^� <br />CONTR. LICENSE # <br />� w �, w� r. �-� �ic o 6 G(' p <br />i1SE OF BUILDING <br />ADORESS <br />CITY2IP PHONE <br />�i'> L S lJ w.R-� vt�l lc. �L2 '� < <br />HEATSOURCE <br />_ Electric ✓Gas <br />WORK DESCRIPTION <br />r�j l c� �-tJ C4 s -t. w�n �. L� <br />U <br />NO. I TYPE OF FU(TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water healor <br />oink (service/bar/mop/elc.) <br />Back(low preventer <br />lirinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� <br />r�ohc��.,�5(� ti82�o 3�co s(o g(}l <br />CONTRACT PRICE OF WORK <br />C� <br />Olher � � $'"7 9� <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas (ireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />lieat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correcL All provisions of laws and <br />ordinaces �oveming lhis lype o( work wiil bo compli�d wilh whelher specified herein or noL The granting of a permit does not presume <br />lo give aulhorily to violale or cancel the provision of any olher slate or local law regulating construction or lhe pedormance o( <br />construction. That I am authorized by tho owner o( lhis propeAy lo peAorm the work for which applicalion is made and 1 comply v+ith lhe <br />Slate Contreclors Law 18,27 RCW and 296200 WAC. <br />IV <br />