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< <br /> _ 1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT FERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857–www.everatlwa.org <br /> APPLILATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CRtDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS ff'S`S�D-G J bR(QlY�ni Wp PARCEL TAX I.D.k PERMIT# <br /> F� 2 �r afiia �os�p9oo3o9odo ��`�ZY��y _ <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYILP PHONE <br /> Fa�� m�yk;2 ttic 3 �Uo sE 9a "AAu� eoah,.vtiD q»o� sos-�s�.��y� <br /> TENANT NAME CONTACT FOR FERMIT PHONE <br /> /U�/.�. Tim wf��erJ- r7�6 y�lb--�Fr�3 <br /> CONTR4CTOR ADDRESS CITY2IP PHONE <br /> =e,��v�ar�o� CQ�s;. s�2ucs . i4q( n1. Nont,a�.o�c,� w�y a06-4Yd--'i dr5 3 <br /> CONTR.UCENSE A �,�j//� � Q�I Q3 //G•/6�L�L�� C'.��� �� <br /> f � Sl"FL• a! �— SfiAirL <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> � _Electric _Gas_Other , S� <br /> W RK DESCRIPTION <br /> F�N� SH �rklSTltiG SPAC � Tv V/1N�LL/i� $G1ry({ ONL/ <br /> _ �r: �, l:� �- ., - ,�, , _ ���� ,. � � �� <br /> // PLUMBING ' MECHANICAL <br /> N0. ✓ TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> i _ Shower _ Waterheater <br /> i = Kitchen sink&disposal = Gas fireplace <br /> Dishwasher Gasrange <br /> Ciothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/moplelc.) _ Exhausl fan <br /> BackOoH prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis application and know the sama to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher specified herein or not.The granling of a pertnit dces not presume <br /> to give authority to violate or cancel the provision of any other slale or local law regulaling construction or lhe performance of <br /> I consW dion.That I am authorized by the owner of this property lo pedorm lha work for which application is made and I comply with the <br /> State Contr ors Law 18.27 RCW and 296.200 WAC. <br /> '� �G�,� �- � 3--v s� <br /> Signature of OwnerlContraclodAuthonzed Agent Date <br /> - -- -- � / <br /> � �/�; <br /> �, ,. <br />