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FcFtMIT APPLICATI`vN <br /> CITY OF EVERETT PERMIT SERVICES ! <br /> 3200 CEDAR STREET, EVERETT, WA 96201 I <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org � <br /> �� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRE55 PARCEL TAX I.D.# PERp�(T� <br /> G�`�0.� r�:�� r �Oo3� .2 � ao�lo I � oo �2�'%%�/(�� <br /> LEGAL LOT NO. BLOCN TRACT OR SUBDIVISION p <br /> oesc. �-, ever i� N�IIS ��v�Sru� I <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Sou+�clUiec.i �onlRc+c�s I� � 3c�x ,�o`I� r`ue�ct+ 9�jz(3 ` S��'7o� 71v7 d <br /> TENANT NAME CONTAC7 FOR PERMIT PHONE i�yS- �7a- 7 2�I � 1 <br /> /��'�'� 1�eck E•MAIL S�f��Gf PfGQP(+ieJ1.L ve(ly�. E <br /> CONTRACTOR ADDRESS CITY/ZIP PMONE /) } � <br /> a � � ���Kr�- �5'8zr3 ���s� s�o- �zy > f <br /> �vn��V;e�.,� Coni-r�i tv�S �U X ,�O ('..7 <br /> CONTR. LICENSE p <br /> �aurc� C� �i51Kc,� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'�U I (�, • �A,w:I y n Y,�Eleclnr, __Gas_Olhcr \� / ��� CJU�i <br /> �(AN�Pntw i <br /> WORK DESCRIPTION ��n� �T�L�n {�n`p�,S _ SL�j�v��' �� <br /> /C /A. � <br /> nSt � 1'VU ��rl� � �__ <br /> PLUMBING MECHANIC�;L j <br /> NO. TYPE OP FIXTUR[OR ITE�d NO. TYPE OF FIXTURE OR ITER1 li <br /> �_ luilu�_ ___—__--_ _— _ irh.�ndlin<� uni�s <br /> �1 N:dhlub __[ Forcei air syslems � <br /> La�atory 4vash b:isin) _ Gas pin� i <br /> Sho�vcr Waj;t hr.aler I <br /> Kilchen sinl,8 disposal _ G s liroplace <br /> - - ��N . cr as range I <br /> Clolhes w isher Clolhes drycr �� <br /> _� \Naler he ler � Ran9c hood li <br /> _ Sink(se +icclbar:mu��'utc.l / Exhaust fan <br /> Backllo preventcr �� <br /> Urinal Unil heater <br /> Drinkin � Founlain _ P�iler � <br /> _ Floor d �in Relrigeralion I <br /> _ Grease Uap — Woodslove I <br /> Roo(drains Olhor_ <br /> Olhor <br /> CITY OF EVERETT LOCAI.SALES TAX CODE IS 3105 <br /> I hereby cerili(y that I have read and examined lhis applicalion and kno�v the same to be dae and correcL A�I provisions of laws and <br /> ordinaces governing Ihis lype of work will be complied wilh�•;hether specified herein or nol The�ranling of a permit does nol presume <br /> to�ive otdhorily lo viulale or c;incel the provision of am�ether slate or bcal lerr reyulating conslruclion or ihe perlonnance ot I <br /> eonstrucli:m. Thol I am authcnized �yJlie'6i•mor of Ihis��roperly lo �ienorm Ihe aork(or�rhich ppplic�tion Is made and I comply�ti�ilh Iho <br /> Slale Cuntrnelorti l,,n IN.2 f 1�'am1�96!200.1NAC. � <br /> �/� � �'�O �CtJf'j � <br /> Signature ol OrrnedContractudAulhoti;ed Ayenl Date <br /> ��Z <br /> __ — i <br />