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f��RMIT APPLICATIUN <br /> CITY OF �YERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8357-www.everettwa.org <br /> APPLICATIONS AF2E ACCEFTED FROM 8 AM T�� 4 PM <br /> SITE A�DRE$5.;.,��{LL��y PARCEL TA,Y I.D.il I pERMITp <br /> s� �?_ �� ✓ '-t`" ( � I'Y1GS i��_G�:.� <br /> LEGA LOTNO. BLOCK TRACT , <br /> DESC. <br /> OWNER �/p� ADDfiESS CITI'IZIP PHONE <br /> _/C:'Gf.l. CL'S'S ��'.2'f77�- sLs-�(D -ff_'c.�P/Z"��'�7i� �G[`�'�- <br /> � ' "?g'z�i�^ 'f�r.34-�. 5'ss Y 7 <br /> TENANT NAME CONTACT FOR PERMIi PHOHE <br /> Lc'�u'�-�5-5 �{�'��Cc: � ����� �`/'Gea�2— ��.L.F'�?S_ Z��- l. <br /> CONTRACTOF AD�RESS CITYIZIP PHONE <br /> �cv�tnt�/�fSc,-�u=c-_ g��� ll-��� ,��� .�tx�-�' �t�s_ sz�s' g��"4 <br /> CONTR.LICENSE N '�g.`�� <br /> USE OF BUILDING I _— HEAT SOURCE CONTRACT PRICE OF WORK <br /> �{/c � � / �� � � ��� •l <br /> ' / ✓'� �'�L �!'��� Electric _Gas' Other / ��� � �' <br /> WORK DESCRIPTION <br /> ��-�c� �Z�%'.=c����'-��/2�G�-c��t zl7c�-r t�-�c ��%-�_ <br /> �"'�' G°�"-�cr'L G c-c?'6�'l C��� 7�—G"�4'�—_. <br /> PL.UMBING tJIECHANICAL <br /> NO. TYPE OF FIXTURE OR IT[M NU. TYPE OF FIX'lURE OR ITEM <br /> __ Toilel � A/C—air handling uni:s <br /> _ Balhtub Forced a7 syslems <br /> _ Lavalory(wash basin) Gas piping <br /> _ Shnwer Waterheater <br /> _ Kitchen sink 8 disposal Gas fireplaco <br /> _ 6ishwash�r Gas ran�e <br /> _ Clothes washer Clothns dryer <br /> __ Water healer Range hood <br /> __ Sink(servioe/badmoplelr.J Exhaus�fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unil heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease Ir,ap Woodslove <br /> Roo(drains Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify;hal I have read and examined Ihis application and know the same lo b�true and correcl All provisions o(laws and <br /> ordinaces governing this lype of work will be complied wilh whether specified herein or noL The granting of a permil does nol presume <br /> to give auGwriry lo violate or cancel Itie provision of any other slale or local law regitlating consWclion or the pedormance of <br /> constr�ction.Thal I am aulhorized by lhe owner of this properly lo perform the work for which application is made and I comply wilh the <br /> Slale Conlractors Law 8. R and 29G.�2° �11�I�1C <br /> `�� �����c,�G�(/�'���1�'S��-� �� --���- OS� <br /> Signalure of nedContractodAuthonzed Agent Date <br />