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�CRMIT APRLI�CATIuN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.evereltwa.org <br /> j�� 'PPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE A�DRESS PARCEL TAX I.D.# PE � <br /> _���� r�:�e� r O 2 00 y 0 I � O o �G�/% "� <br /> LEGAL LOT N0. BLOCK TRACY OR SUBDIVISION# <br /> DES0. �`� C�.UCJ"Il � �S �ViSiOl� � <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Sou,��U�e�.� C`o,�+R�+-�s I��C� 'l�ux ,�0`l3 tve�ct+ 9bz�3 �lzs�e�o� �z�r� <br /> TENANT NAME CONTACT FOR PERMIT PHONE [�iS- Qj7p� �I z�I 7 <br /> MA �'�' �eck E-MAIL 5����V' PfCQPf+itfl� U� �� <br /> CONTRACTOR ADDRESS CIT I21P ONE � � ' <br /> �,unclvreu Cani-rcifv�S ��U I.�C�X �G�f3 �ucrc(-�1- '�7FJZf3 �/�S� �7o- 7�2�/ 7 <br /> CONTR. LICENSE p <br /> �o�,v�c� CL i51Kc,� <br /> USE OF BUILDING�� / HEAT SOURCE I CONTRACT PRICE OF WORK <br /> n��•,Mti� �- <br /> �i��y.�(,� ,��y ��_Ar�� �[ledric _Gas_Qther �S�J� pU�j <br /> WORKDESCRIPTION Y��/��� ��,��n�„�p�.s _ S�PA��S-�;r�9 <br /> nsf C i'VU UR,' T <br /> PLUMBING MECHANICAL <br /> NO. TYPC-OF fIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> _/�_ uilcl �— __ - ir handling unils - I <br /> _�1 Ralht�ib / __ Forca air sys�ems <br /> La�-alory I���ash b:isinl :.. _ Gas pinc� <br /> Shuwcr _ lNa n c�atcr / <br /> Kdchen sin6,h dis����s;d � G� s lireplace <br /> ��a .. er / as range <br /> Cluthes �v �sher ./ Clothes dryer � <br /> _�_ 1Nalen c� ler Range hood / <br /> _ Si,�k (sc ;ice�barhnop'ulc.) I � [>:hausl lan � <br /> (3ac4;llo r prevenfcr <br /> Urinal Unil heater <br /> Drinkin� Founlain Boiler <br /> Floord ��in Refric�eralion <br /> Grease trap Woodstove . <br /> Rool dr2ins Olhor <br /> Other <br /> CITY OF EVERETT LOCA'_SALES TAX CODE IS 3105 <br /> I hereby ceritlly Ihat I havc read and examined Ihis application and know the same to be lrue and correct All provisiuns ol laws and <br /> ordinaces<�overnin� Ihi, lype ol�vork�vill br complied with�vhether speci(ied herein or noL The granting of a permil does no�presume <br /> lo c�i��e authurily k� ��iolate nr cancel Ihe proaision ol any olher stale or local lav:reyidalin�construction or Ihe pertonnance of <br /> conslruclion. That I .im ;mthorizud �yyre'6��ner ol Ihis property to-jierlorm the wvrk(or r;hich 2pplicalion is made and I comply wilh the <br /> Slale Contra�lorti L�nv Ift ��� 1'Y:u+ct.' �'Ol).1VAC:... <br /> / ..i <br /> / � <br /> � �� i " �I.'.2, ,ZCtJ�ji <br /> � =� <br /> Signalure ol OwnedCont�actodF�ulhnrized Agenl Dal� <br /> /Z <br />