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PLRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR 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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # <br />gERMIT # <br />,2o RL��E2 Ll SI17(oiOfD <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />3Q.o l 2uckE2 LLC. tsy-O M(A2.tQe -t-)r- . �I�AR�rv.tic �i8L'L 1 6 Y e-- 2 Yv <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Mro-V_ L 2CIGh1ty1 <br />I MisYIL t_ /Zelchl/n 3Go-(058-'l�/y� <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />n(o n E2 aollot o_. <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEA\T/SOURCE I CONTRACT PRICE OF WORK <br />"Z155 1 GlU r`r^-1�'1 <br />_, Electric J� Gas _ Other 2 y, aLl <br />ii7""""' <br />WORK DESCRIPTION <br />E1C�t y-10r- (LEC00:5+Y'o Io� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C —air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />_ <br />_ <br />'hater heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heal pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />_ <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerility that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Slate Contractors Law 18.27 RCW and 96.200 AC. <br />Si of Owner/Contractor uthonzed Agent ate t(Z <br />g 71, <br />