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SITE ADDRESS <br />1022 93RD ST SW <br />LFJ�AL LOTNO <br />DC`C <br />SUSAN PEREIRA <br />TENANTNAME <br />�ONTRACTOR �A/�SCO <br />vv <br />PERMIT APPLICATION <br />r,ITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-?57-881 � — FAX 425-257-8857 — wv�nN•everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM Ci .� ��'� �� <br />BLOCK <br />cor+rR. ueeNse n WASHIES971 OB <br />USE OF BUILDING <br />residential <br />WORi< DESCRIPTION <br />PARCEL TA% I.D. it <br />0053A000002900 <br />TRACT <br />PERMIT p <br />IM Ilb9�C�� <br />SAME AS SITE ADDRESSS Everett 9Ft2oa d?.5-493-3684 <br />CONTACT FOR PERMIT PHONE <br />Cyndal/Naida 360-945-2787 <br />ADDRE55 qT/21P PHONE <br />2800 Thorndyke SEATTLE 800-398-4663 <br />HEATSOURCE <br />_ Eleclnc � Gas _ Othef <br />REPLACE GAS 40 GALLON HOT WATER HEATER <br />NO. I TVPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />ShOwer <br />kitche,i sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />LaunAry tray <br />Sink (seroice/bar/mop/etc ) <br />Backllow preventer <br />Urinal <br />Drinhmg Fountam <br />I'loor Arain <br />Grease trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />750.00 <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handhnu �u�il5 <br />Forced air s��srems <br />Gas piping <br />i Wate: hea[er <br />Gas Ineplace <br />Gas range <br />Clolhes dryer <br />Ranoe hood <br />E�haust fa�� <br />Heat pump <br />Untt heater <br />Boiler <br />Reingeration <br />Wootlstwe <br />CITV OF EVERETT LOCAL SALES TA% CODE IS J105 <br />I hereby cerrtity that I have read and eMamined this apphcadon and hnow the same to Ue irue antl correct All provisions of laws and <br />ni,y�naces governing Ihis type ot worh vnll be complied with whether specihetl herein or nnt The grandng of a permd does not ptesume <br />t�� y�.ve authonty to vwlate or cancel the provisinn of any other state ot local law �e�julahng mnsituc0on ot ihe perto�mance of <br />cunstructwn That I am authori_ed Uy the owner of this property to perform the wnrh for whch applicapon is made anA I comply wdh lhe <br />(.tate Contractors Law 18 :7 RCW and 29E 200 WAC <br />, ,_ 9116/11 <br />`<�.��:mature o OwnerlContractorlAuthonced gent Date <br />