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SITE ADDRESS <br />LOT <br />TENANT NAME <br />wninnc�un �11�GC� <br />As;c�ctci <br />CONTR. LICENSE # <br />A ►-� <br />USE OF BUILDING <br />� <br />WORK <br />N0. <br />PERMIT APPLICATION <br />CI�'Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />c � oo� � <br />� <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (servicelbar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Groase irap <br />Roof drains <br />Other <br />N`� <br />� PARCEL TAX I.D. # <br />� ooH373A1 �ol � <br />TRACT OR SUB�IVISION M <br />CONTACT FOR PEf <br />L; ��+b <br />a�a� C�t6r <br />HEATSOURC <br />_ Electric _ as _ Other <br />NO. <br />PE MIT # <br />�/������ <br />:ITYIZIP PHONE ��-� <br />�erc-tf4R�� j �54-'i��i <br />PHONE y��`�-�.`� � <br />E-MAIL KBt7E.Ll..l�� p�,(S£Il <br />k�f �� ' <br />q8�a f • ,�e� <br />'f aS as�i-�Ds J <br />CONTRACT PRICE OF WORK <br />38 �'70O9C_ <br />:-o�.-t-, � poxY, resi-eel <br />EC ANI L <br />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 />Range hood � <br />Exhaust fan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby certify that I have read and examined Ihis application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied wi!h �vhether specified herein or not. The granting of a permit does not presume <br />to give aulhority to vidate or cancel lhe provision of any olher state or local law regulating construclion or the performance of <br />consiruction. That I am authorized by ihe owner of Ihis property to peAomt the work forwhich applicadon is made and I comply with the <br />State Contractors Law 1827 RCW and 29�.200 WAC. <br />��S- �d <br />��Z <br />