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FtRMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320U CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—�vww.everetiwa.or� <br /> �f� 'APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS J PARCEL TAX I.D.# PERp�T� <br /> �/�n7 A:�e� r O ��j2 �''UOyO � -10 � I �J�'// "U/9 <br /> LEGAL� LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC.I �`' C�.UC:(lr N���S 1��ViSiU/� � <br /> OWNER ADDRESS CITY2IP PHONE <br /> Sou��u�ev �'o.�iRc�s I�•C� l'wx �0<13 Fve�c++ �ibzl3 �/.ts•B�o� �av� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE (�ZS. �7U. 7 z i� � <br /> MA'I 'F �QCh E-MAILS'�f��lnlP�O(!P(+ie;1� V�( �A <br /> — � � <br /> CONTRACTOR ADDR[SS qTYIZ�P PHO E + � <br /> ��v„cI Ur ev Cantnc tv�S Q c� 1,�G� �G�13 �vuc f-f- '`i8213 �/ZS� ��o- 72=/ � <br /> CONTR. LICENSE# <br /> ��uv�clCL �i51 Kct I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'�U( �"� ' 4Aa,_'1y ,1 �Electric _Gas_.Other \� �S� UCJU I <br /> 11�Ar7-r..c..i / <br /> WORKDESCRIPTION �/�J/�� ��.,��n����,s - S�nA�,�7 I <br /> o � <br /> , ,. S+ � -rv� �,�, ,— , I <br /> PLUMBING MECHANICAL <br /> NO. TYP[OF FIXTURH OR ITEA1 NO. TYPE OF FIXTURE OR ITEId I <br /> _�� iuil��l -- --- -- --- L�' — ir handlin9 unds � � � <br /> � fialh�ub ---� f-orcu� air systems I <br /> La�•alory(wash basin) _ Gas ping I <br /> Shnwer lNa n c�atcr <br /> Kitchen sink 8 disposal G s fireplara <br /> �� � , cr as nnpe I <br /> Clolhes w isher Clothe, dryer <br /> _ '� Waler he ler Ranye hood <br /> Sink(se ,�icelbadmop/elc.) / o [ahaust fan <br /> B.ickllo :prevontcr <br /> Urinal Unil heater <br /> Drinkin � Founlain Boiler <br /> Floord iin Refriyeralion <br /> Grease trap Woodslove . <br /> Roof drains Olhcr <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritily Ihal I have road and examincd lhis applicalion and kno�v the same tu be true and correcl All provisions of laws and <br /> ordinaces governing lhis typo o(work will be complied wilh�vhether speci�iud herein or noL The grantinc�of a permit does not presume <br /> tu give aulherily lo viol�le or cancel Ihe pro�.isioii uf an}�olher stale or local lav;reyulatiny cunslruclion or the per(ormance el I <br /> ronslruclion. That I am authorized bp11iP'6��ner o�lhis property to �iHrlorm ihe erork for e,hich ;ipplicallun is made <and I compl; with the <br /> Slalc�Contraclors,j�aw iR.'27.. :l���c1;:�6!10p.lNAC: � � <br /> �.:�" ""/ �' _ . <br /> � � � . ��L'�.0(�lJ� <br /> Si�nature ol O�.vnedContractor��uthorized Agent Dale ��L <br />