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� P�RMIT APPLICATICrN � ,� <br /> CITY OF EVERETT P�RMIT 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 SSDS �V�p�p..F,F-N wkY PARCEL TAX I.D.# PERMIT# <br /> VEa,cY't" �wft `16203 0 3 ZCn 4�VDa � - > <br /> LEGA LOT NO. BL,OCK 7RAC7 ' <br /> DESC. <br /> OWNER AUORESS � CRYZP pHONE <br /> S�-e.vr_�. 2 1�1 e��.. 1'o C3�;c 3�3o F���s H �94203 4z.5= 3�' 3��� <br /> TENANT NAME I CON7ACT FOR PERMIT � PHONE <br /> ..rrr,�P�� R n�T-.q--ca2 �eFr �t�toe�.�5 S�ZS-5S -ZZSS <br /> coNraqCTOR � C u.-. ZS"3-77�-6&07 <br /> A'u�F16o.� ONcEPT�,�C.L.C. ADURESS 3SLl 6A.cnfo.tivs� r��T�447riq PHONE <br /> CONTR.LICENSE# �R�HL� 00I M2 W� `�P4L2 <br /> USE OF BUILOING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �.JrDMo't31L� P�.vyA�L —Electric _Gas_Other I /D'S 4 �O <br /> / <br /> WORK DESCRIPTION i��vn.�r YMPfJJ�tMlL"F Fo�-q NtW EM@L!'n5E 2f.vrA-oq.� o�+U-i,soqv� �F u..�c sMr; � <br /> TNLc�OF LS✓T�✓7 Lih.TEo To� SZIacY iN77C[�cG D�NbNT/aV�$EGgC'f �VG w ln.7��eL WACliS NFu <br /> TN*Grt<u�4^o0' PAF.nT�wS, 46rfT[�+a'iPLlCctf�cq�RLV�vorv '-��K'b� P~✓vIi/,S-i <br /> a � 5,. Plu.ab�w ¢e.umcxS.��ic*E¢w�V <br /> FL�visicn.4, /}�✓�Lu/Hq�+�u+P�D '��E�,� /�&6TPoa+7 rq�,eny w��L��l�-so -c� teotyrre�7tap°��{ K[r�ell•wttsw-. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTllRE OR ITEM NO. TYPE OF FOfTURE OR ITEM <br /> � Toilet A/C-alr handling units <br /> Bathtub Forcad aIr systems <br /> / Lavatory(wash basin) � Gas plping <br /> _ Shower Water heater <br /> _ Kitchen sfnk&dfsposal � Gas flreplace <br /> _ Dishwasher Gas range <br /> _ Clothas washer Clothes dryer <br /> ,_ Laundry trey Range hood <br /> _ Slnk(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> Drinking Fountain � Bofler <br /> _ Floor drain Refrigeratlon <br /> ,_ Grease Vap WoodsUrve <br /> _ Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby ceritify that I have read and exanined this applicatlon and know the same W be�true and correc[. All provislons of laws and <br /> ordlnaces governing this type of work will be complled with whether specified herein or noG The grantlng of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulatlng constructlon or the porformance of <br /> �onstructlon.That I am authorized by the owner of this property to perform the work forwhlch applicatlon is made and I comply with the <br /> ate Contractors Law 18.27 RCW and 296.2C0 WAC. <br /> �l�—� �-� :.�, � e s?�� <br /> �3 re nerl ontracto Authodzed Agent ate <br /> �IZ <br />