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Aug. 29. 2012 12:18PM <br />Nn.5042 P. 4 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3201 CEDAR STREET, EVERETT, WA 08201 <br />425-257.8010 — FAX 425-257.8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />53I fats STS <br />LEGAL LOT N0. <br />DESC. <br />Kaus- Lent <br />TENANT <br />PARCEL TAX I.D. 0 <br />Ev 6a2a 3 <br />BLOCK I TRACT OR SUODIVISION N <br />sa.rne, <br />-a9- .12 <br />PERMIT,M�r� <br />HOIIE <br />s 43$ 271D 1 <br />s <br />1weib w" E:Vtcett g006'r ►}Z52` 1066� <br />CM 14 AIRIn <br />,ONTReI I SE `i O �� <br />1r� HEAT SOURCE CONTRACT PPICC OF WORK <br />USE OF BUILDING GG�J <br />—Electric Gas —Other 'l J ISl <br />WORK DESCRIPTION RU(N qQS� N�OI �'P r rC r�Q <br />\nsFa11 etas insert <br />�n5'Iza ll 1�'20 -t�-n I� <br />PLUMBI Q EC ANICA <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF roam OR ITEM <br />_ Toilet <br />_ Bathtub <br />Lavatory (wash basin) <br />Shower <br />_ Kitchen sink 8 disposal <br />_ Dishwasher <br />_ Clothes washor <br />Water heater <br />Sink (service/bar/moplelc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />_ Grease trAp <br />_ Roof drains <br />Other <br />NC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas flreplaco <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />WODdsI0v9 <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby carilly that I havo read and examined this applcatlon and know the same to be true and correct. All provisions of laws and <br />too give a uhortly t �vlo tea cano of es In@ provision will be of any Willi <br />other state or1locfae aw repulalingrein or 'constructThe ogranting I a of a padormermit anca of s not presume <br />construction That I am authorized by the owner of this property to perform the work for which application Is made and I Comply with the <br />State Contractors Law 10.27 RCW and 290.200 WAC• <br />I l]k`A �rr Oh� f <br />S gnaw of Ownerl apt actor/ uth genI ware <br />