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F�rRMIT APPLICATIE�N <br /> CIITY O� EVERETT FERMIT SERVICES <br /> 3200 C EDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM U D �Q�-C13� <br /> SITF ADDRESS I�J� PARCEL TAX I.D.# PERMII # <br /> 1c� d5(� $ -G <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER �Q���.�� A�I�15 _ CITY2IP � PN ��� �27 <br /> �f0 � y� �D <br /> �'ll�t����'t'�, ��Q.'�1�� VW �.-��o �Y�(�.`�' 1 <br /> TENANT NAME CONTACT FOR PER T PHONE <br /> �Yl� �S �`1�12. _ � <br /> � <br /> CONTRACTOR ^ �(�{.^'(�DLIRESS��Q ��y CI1Y21P PHONE �� 2 <br /> ` � aicv♦ 4�y,,,� f �—Crl�7 <br /> ��'�_� c�4 F+� y.l/1�.�.'l <br /> CONTR.LICENSEp �-'^ ���QS�,�� �Q` � <br /> v��� �-C�fj� <br /> USE OF BUILDING I�EAT SOURCE CONTRACT PRICE OF WORK <br /> ��b(� ����~ -� I _Eleciric _Gas_Other 7�?�J���� <br /> WORK DESCRIPTION �e�� � �pj'� ,� <br /> q F�n��la-F;a� � v�e���rr� -� be �•rr.�J, <br /> � s���e �d���y ���x-�e � a���, <br /> PLU BING MECHANICAL <br /> NO. TYP[OF FIXTUR�:OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel FVC-air handling units <br /> Bathluh Forced air systems <br /> Lavatory(wash basin) _ Gas pipin� <br /> Shower W a�er healer <br /> Kitchen sink&disposal _ Gas Greplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Laundp�lray _ Ranc�e hood <br /> Sink(serviceNarhnop/etcJ __ Exhaust(an <br /> Backflo�v preventer _ Neal pump <br /> Urinal Unil healer <br /> Drinkin� Fuunlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ 1Noodstove <br /> Roof drains Olher <br /> Other <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerili(y thal I have read and examined lhis applicalion and know lhe same to be true and correcL All provisions of laws and <br /> ordinaces goveming this type o(work will be complied wilh whether specified herein or not.The granling of a permil does nol presume <br /> to c�ive aulhority to viola!e or cancel the provision of any olher stale or local law regulating construction or the perfomiance of <br /> conslrur,tio Thal I am authorized by the owner o(Ihis property lo perform lhe work for which applicalion is made and I comply with lht <br /> Stalo Co ractors La�v 18.27 RCW and 29G.200 WAC. <br /> s � ' � � �p,Y'U�[� <br /> Signature of Ow edContractor/Aul orized Agenl Date <br />