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�ERMIT APPLI�ATIVN <br />CITY �F EVERETT PERMIT SERVI(;ES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLIGATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 5_ � S`-D� <br />SITE ADORESS ` I /1� <br />"� )% VI SG; r N I� /'t'��C: <br />LEGAL LOT N0. BLOCK <br />oesc. ii r i(, G3 j <br />f�� Ic_ .�'j4GETC}I <br />PARCEL TAX I.D. # � PERMIT # <br />c:u)S' 37 &� 33ascD ' )`'(7 <br />TRACT OR SUBDIVISION # <br />t�vC2.t�i ��v 1 <br />AODRESS CITY2IP PHONE <br />l7C7 3D�c 7/� �VtR�7 i.vAri,Y2V6 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />�lir ��cnt1-1 _FD G�sc�+ 42s So% ¢�S2 <br />E-MAIL�.�'tso�v N.dv4c�ncE+�n�l.i6 <br />CONTRACTOR ������ �,��� � �NL AD�RE-- S�— CITYIZIP PH—T7N�— <br />�7zL ���c���e •4v� 4�s zs�'i-�3N <br />CONTR. LICENSE il 1�V rY' � il 4.".�.2�� <br />�'�iFG% 0;3��+`� <br />USE OF BUILDING <br />v�i �-'�.�aC' <br />WORK DESCRIPTION � UN �,�L� ; <br />NO. I TYPE Of FIXTURE OR ITEM <br />Toilel <br />Elathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler healer <br />Sink (service/badmo�'elr,.) <br />BackOuw prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roa( drains <br />Olher <br />HEATSOURCE <br />�i/'�i,�.L ` <br />Electric Gas O�her <br />�v� � ot-�,x�,�, 6.a�:G <br />CONTRAC'i PRICE OF WORK <br />�rL'.Lt�U <br />NO. I NI'E OF FI%TURE OR ITEM <br />A/C - air handling unils <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeralion <br />Woodslove <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify Ihal I have read and examined lhis application and know lhe szma lo be lrue and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied wiPi whelher specified herein or not. The pranting of a permif does nol presume <br />lo give authorily to violate or cancel lhe provision ot any olher state or bcal iaw regulatin� construclion or the perlormance of <br />conslruction. That I am authorized by lhe owner of ihis property lo peAorm lhe work fer which application is made and I comply wilh lhe <br />Slate Conlraclors Law 1 27 R' anc� 296200 WAC. <br />� . ��� / <br />2Y/d� <br />1 /Z� <br />i_ -- -- - -- — ___ ' <br />