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PERMi'r APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3300 CEDAR STREET, EVERETT, WA 98201 <br />425•257-8810 - FAX 425-257-88:�7 - www.evereL`wa.org <br />APPLICATIONS ARE ACCEP7ED FROM B AM TO 4 PM - DEBIT & CRE�IT CARDS ARE NOT ACCEPTED <br />PERMIT i I <br />�' ��`� �/' ( I <br />51'CE ADDRESS 81� ��G��M <br />LEGAL LOT NO. BLOCK <br />DESC. �--�� J,-'T7 CHFp — <br />OWNER <br />'�vt �r+ip �1L-ci,i2S <br />TENANT NAME <br />ih7a�[�ot� ��of� <br />� / PARCEL TAX I.D. # <br />� <br />y �- <br />TRACT <br />ADORESS CITYfZIP <br />67s 3 "A ,�„� t� Z�to �-I ' <br />CONTACT FOR FERMIT <br />'�U2GLif �E� �EJL <br />I�Y/iN ��i'n �, �Lten GrrwD <br />CONTRACTOR '�'� M N /> M h AD�RESS <br />W1� j' �:o p�l Y, L� � <br />CONTR. LICENSE # <br />� -�-QM � �.�� � so a,a <br />USE OF BUILDING <br />�-D��e.�. ��icF <br />WORK DESCRIPTION <br />�'f'll'Tl�-. —�T�tl,.rt-+ <br />CITYIZIP <br />�PO BOx �5�8 <br />i�6��(,bh'1f7� �� <br />HEATSOURCE � <br />Eler.tric Gas _ Other <br />Z12•661•0`iDD�I <br />�pol� � <br />ZoG • Sb7 -7/2� <br />PHONE <br />'.�(p .Z70 •q75? <br />CONTRAGT PKlct t�r w�rcn <br />250 �pp ^�_ <br />Ir�(�Rw �h�'1 ��U�✓L �U� j�S +�"� cA � n- G Q� � l't' �5, <br />�p, I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Sho�ver <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Lawidry tray <br />Sink (service/badm, -'�tc � <br />Back(lov: prevente� <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Olher <br />NO. I 7YPE OF FIXTURE OR ITEM <br />AIC – air handling unils <br />Forced air systems <br />Gas �,-�ping <br />Water healer <br />Gas freplace <br />Gas range <br />Clothes dryer <br />� Range hood <br />Exhauslfan <br />Heal pump <br />Unit heater <br />Eoiler <br />Refrigeralion <br />'.Voodslove <br />Olher _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3�05 <br />I hereby cerili(y lhal I have read and examined this application and knov� lhe sa�^.e tn be true and correct. All previsions of laws and I <br />ordinaces govemin9lnis type of work will be complied vrith whether s�ecifed harein or not. The grantinq of a permil does not presume I <br />to 9ive aulhorily to violate or cancel the provision of any other state or local law regulaling construclion or the performar�ce of <br />conslructior�. That I am authori::ed by Ihe owner o( this oropeity fo perform lhe work fur whicn applicalion is made and I eomply wilh lhe <br />Siate Conlra� ors La�•r 1 W and 796.200 WAC. �n7p�-r Ih�Fo �, <br />04.0�•�� 'P�z�ss k1t.i��z�c,r 6'"°,.'(�� <br />S�gnaturc of Ownen on�ractadAulhorized A9en1 Date Z06• �f37 • 7120 <br />i3zG s�� Q� .� 500 <br />- `--r <br />5�d--�iiz �lJA �t8161 l � <br />