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SITE AODRESS <br />LOT NO. <br />TAc� i E G�+i �► <br />TENANT NAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-B810 -- FAX 425-257-8857 — www.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLOCK � TRACT OR SUBOIVISION N <br />�i�qq�iP� <br />ICONTACTFOH <br />��� � <br />PEflM1T p <br />�i'�i � .} � l Li <br />CITY2IP PHONE <br />�{�,S 3sr, <br />PHONE <br />y2s-��s-�y�/ <br />CONTflACTOR ^"' "'r L yN��� <br />DN'r �'i✓irE PtrtiaG �- ffTCT /Glcl�l 3�-Av.e•w• 94�37 �7�-775�G�/G� <br />CONTR. LICENSE M <br />USE OF BUILDING <br />WORK DESCRIPTION <br />/?�vcAcE <br />�=u,a�,�c� <br />HEATSOURCE <br />__Cleclnc �Gas. Other <br />CONTRACT PRICE OF WORK <br />� s,a�6.�5 <br />E,c � s-n,��`� C�,4 s i=U �c►✓A-cE cv i�}+- i� l�e�,v GhS <br />.�n� T"n � SAwt� L-lJ�iTlO n.� . Ab N2�J CrAs �1 �i�� : <br />Np. I TYPE OF FII(TURE OR ITEM <br />Tailr.l <br />n,wi�m <br />l nvalory (wash hasin) <br />Showor <br />Ki�Chen sink R d�^.postil <br />Uishwashri <br />Clo�hrs wnshrr <br />Woter henlm <br />g�nh (sorviCn4�ai lnnp'rlr ) <br />❑,icklloW prevu�dm <br />Urinnl <br />fhinking Pount:un <br />I Inm drain <br />��irnse Irap <br />Ruul dr0ins <br />Ulher <br />NO. I TVPE OF FIXTURE OR ITEM <br />NC - air handhnc� unds <br />Forcod nir systems <br />�,5 P�Pn,a <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ran�7c hood <br />Exhaustlan <br />Healpump <br />Unil healor <br />�oilw <br />Rolri�eration <br />Woods�ovB <br />Olhr.r <br />CI1V OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br />I hmeby corilily Ihat I have rond anA exemined this nppLca6on and know �ho snme lo be t« i� end wrrecL All provisions ol laws end <br />ordmaces �ovorning Ihis type ol woik will be comp6ed with wheDior specilied harain or noi. The g�anting ol n pormit doos nol presume <br />lo pive nulhnriry lo violnle or canr.rl Ihe prnvicinn ol airy othflr s1ale oi loc�l law regulnlin� consiruclion or Iho pedormanco of <br />conslniction. Thal I nm aulharized by Ihe owner nl Il�is pioparty lo poilo�m ihe work lor which apphcation Is made and I comply with Ihe <br />