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� F��RMIT APPL9CATIt.N <br />CITY OF EVERETT PEi2MIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE AGDRESS -#r L PARCEL TAX I.D. # <br />�lZ�� �aRti^!p AV� ��y'>?S?330f?oo <br />LEGAL LOT NO.n BLOCK TRACT <br />DESC. I% "Ic�� I�I i3 3 E i/��� �ll� �"'I <br />l <br />OWNER ADDRESS CITY2IP <br />{�{20 �V£" t,oQ✓r�r�.-r- �t �� STP.UC't�� wC_ <br />� <br />TENANT NAME I CONTACT FOR PERMIT <br />�V�v✓ LcrJ->"T7? . 'N_ Fi. �Jo(-�nl OC�o(�5��-�� <br />CONTRACTOR ADDRESS <br />P I� � Sf�-'Ls'Fvt'r.%-r � 41 C�z���-uC'i� s.J <br />{.�. ����x cz3z L <br />CONTR. LICENSE # � <br />�'IZuVF�(Jf �lbZ �C� <br />USE OF BUILDING $��%L <br />�. .,�T �i U.,e 2 <br />� C ./��7l15� <br />a <br />�2��Z�Z-i�tg <br />PHONE <br />'�t25 - Z� 2 - I �-f <br />CITY2IP PHONE <br />��f�-�c- �� 2?2-IKS <br />HEATSOURCE I <br />_ EleGric � Gas Olhcr <br />CONTRACT PRICE OF WORK <br />.,, <br />; y�� ��.�, <br />WORKDESCRIPTION ���t_y.��_�./� � �_, _.�� ��� <br />/i�i,'L>�D Sin/vu= F.aia��.y /�Ji['�.: ��r= ,?.�:� <�.Ltii� - -- — <br />i <br />r��� E-cqQ caA��� _ il�'�% — — <br />VO, I TYPE OF FIXTURG OR ITEM <br />Toilel �/ <br />Bathlub � / <br />Lavatory (wash t3sin) , . <br />Shower <br />Kilchen sink & disN�sal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (serviceNar/mop/elc.1 <br />Backllow prevenler <br />Urinal <br />Drinking Fountaln <br />Floor drain <br />Grease irap <br />Roo( drains <br />Olhor <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C – air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace / <br />Gas ranc�e <br />Cbthes dryer <br />Range hood <br />Exhaust fan /�/ <br />Heal pump <br />Unit haator <br />Boiler <br />RefdgeraHon <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have re2d and examined this applicalion and know tho same lo be lrue and correct. All provisions of laws and <br />ordinaces c�oveming lhis lype of worl: will be complied with whelher specified herein or nol. The granling o( a permi: does not presume <br />to give authority to violalo or cancel the provision of any other state or local Iaw regulaling construclion or the performance of <br />conslruction. That I am authorized by tho o�vner of lhis property to perform the work (or which application is made and I comply with iho <br />Stalo Cpntrostors Lalv_7�1.2I-F3CW and 29G.200 WAC. <br />