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P'tRMIT APPLlCATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVER[TT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettvra.org <br /> ��� APPLICATIONS ARE ACCEPTED FROM 8 AM TO�� PM �� �j7� �Q��I <br /> SITE ADDRESS I PARCEL TAX I.D.fl P MIT ft <br /> XXXK 3AKP. rtUL co 1 i o .7�,r�'�r ��D�� �r <br /> LEGAL LOTNO. BLOCK TRACT1 /1 <br /> DESC. 3 �..�V�(1 S NariR'e i'G1�2 <br /> OWNER ADDRESS CITYRI' PHONE <br /> ��„� C-�,s}�,�. �u,. ��c, 1815 f� 7���g-�C ,vc �,�I�, wA . 9�,0 <br /> TENANTNAME ,_� CONTACTFORPERMIT yt$. 3,�.6y►o°�H�- <br /> (�//�1G���) T�s�c Gros�_yz�-at8-oy10 cQ�l _ <br /> CONTRACTOR ��N� 5 CAw� T�1C, ADDRESS CIN21P PHONE <br /> � `1P)'- 377-�`f/D <br /> CONTR.LICENSE N l7«<lMC T R� SQL ���5 �77f k�� NC �10�1y� -/PZ'G <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> —��/Z — _Eleclric ,�Gas__Olher �LfJ�� <br /> WORN DESCRIPTION <br /> %l�� l.V 5 � �� <br /> PLtJMBING MECHANICAL <br /> NO. TYPE OF FIY'TURE OR ITEM NO. TYPE OF FI%?URE OR ITEM <br /> Toilot A/C-alr handling ur.its <br /> . t Bathtub � Forced air systems <br /> j � Lavatory(wash basin)-� �_ G.^.�piping <br /> Shower � Wa1er hoaler <br /> � Kilchr.n sink&disposal � Gas lireplaco <br /> J_ �ishwaslier �_ Gas range <br /> �_ Clolhcs washer J__ Clolhes dryer <br /> � Waler healm � Ran�7e hood <br /> � Sink (servicolbar/moplcic.) �_ Exhaust fan <br /> Backflow prevon�er Heal pump <br /> Urinal Unit hoater <br /> Drinking Foun�ain _ Boiler <br /> Floor drain R�Irigeralion <br /> Greaso lrap _ Woodslova <br /> Roof Arains Other <br /> Olher — <br /> � -- — — <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I <br /> II hereby ceritiy that I have read and examined this application and know lhe same to be true and correcL All provisions ot laws and <br /> ordinaces c�overning Ihis type ol work will be complied with whether specified horein or noL The 9ranting of a permit does nol presume <br /> to givo authority to violato or cancel the provision of any olhei state or local law regulaling wnstruction or Ihe perlormance ot <br /> construction. That I am authorizod by lhe owner of this property to porlorm Ihe work for which application is made and I comply with tho <br /> Slale Coniraclo�a���296.2J0�_ <br /> ' �� � — /D 3 OG <br /> � ignaWre o u�� or/Authonzod Agc Date <br /> � �� -- ��z <br /> , _-- -- _ -------- ---- - - --------- <br /> ��' 3��i� - 9�'�� <br />