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SfTE ADDflESS <br />LEGA�4 L O <br />DESC.r i <br />� <br />� � <br />, � ,,. <br />TENANT NAME <br />j� �'� <br />0 <br />PERMIT APPLICA,TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetiwa.org <br />APPUCA710NS ARE ACCEPTED FROM 8 AM TO 4 PM 7'� a'� <br />PARCEL TAX I.D. p PERMR 1 �� <br />� �� , �� , �; � , , � ', l �, ` / �'� ���; ( <br />BLOCK TAACT OR SUBDIVISION f / �� <br />tl .��'�. :rr � r��. t �� �r��lr. ����.v'1 ��(�c4� <br />',- t'e�',i�_IN <br />� CONTACT FOR PEPo <br />� �k �. I f. o(,.'Ir�jF�<<y lil`� %17 7�21.� <br />PHONE '.I i 1", i� i%> Ip 7�d'r: <br />� � <br />,'( , i i ti f '' E-MAIL � � �� � � . (:' �i.n`u� '�� <br />� � r � , ., �` � C� , �.,. CRV/2 ' - <br />.� , . �� V� i ' ��r�. , . � <br />� � i� � <br />CONTR. IICENSE / ' <br />� iF'"..�,r.' 4� �j"=!rr� . <br />USE OF BUILDINq <br />, . �, I ,� V� <br />� <br />1 .��. {f.rl; <br />WORK DESCRIPTION <br />r���„r14':l (,,- � <br />I.��� 't�rl� i J � . <br />NO. � TYPE OF FIXTURE OFl IfEM <br />� <br />� <br />1 <br />Toibt <br />Balhtub <br />Lava�ory (wash Lasin) <br />Shower <br />Kilchan sink R dis{x�se+l <br />Dishwashei <br />Clolhes washer <br />Water hee�er <br />Sinl, (servi<r.R�erimcp'sl�..l <br />Hackllow p��veiw r <br />Urin21 <br />D�inking Founi.=��, <br />Floor d�ein <br />Greasetrap <br />HCAT SOURCE <br />Elec G2s Olhor <br />' '/ <br />� „ li 1. <br />NO I <br />__—_ — ._..—__.L— <br />I <br />� <br />�_ <br />1 <br />L} <br />r. ��� <br />r . �','_ <br />I CONTF ACT PRICE OF WORN <br />TVPE OF FlXTURE OR ITEM <br />lVC - eir handlirg units <br />Forced air syslems <br />Gas piping <br />Walei haater <br />Gos liroplar,e <br />Gas iange <br />Cluthes dryer <br />Range hood <br />Exhausifan <br />Heal pump <br />Unil heater <br />Boiler <br />RehiBere�ion <br />Wrwdstove <br />i � Rool drains Olher <br />------'--- <br />' Olher .._ .. _ . . ----------- <br />I ___ <br />� CITY OP EVEHEIT LOCAL SALES TAX CODE IS 3105 <br />I I hereby ceritity that I have read and examined Ihis a{�licetion and kiww tlie same to be true and wrrect. All provisions ol laws end <br />ordinaces goveming Ihis lype of work will h:omplied wlih wtiether specilied herein or nol. The grenting d e permit does not presume <br />j iu give eutho�ity to violate or cenr.el tlie pr�oision of any olher stete or local 12w regulatlny consiructlon or 7he performance of <br />� cansVuction. Thut I em au�horized by �he owner cl this propeAy to perform Ihe work for which applicallon is made end I comply wilh Ihe <br />State Coniract�rs Law 10.27 flCW and'196.200 WAC. <br />I1 <br />Sig fure o er onlrecloU ut nz gtril �� afe <br />