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PEKMIT ,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 i�M <br /> SITE ADDRESS `'3 ��.� grca� �v n�� PARCEL TN(I.D.# PERMIT p <br /> r��r,- 1//� 9�3�� � , a , � �OI 3�'-r. fl /nD 3 - � � <br /> IEGA LOTNO. BLOCK TRACT <br /> DESC. � �, � (. <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> Sc•,Itimin/Fr >/a� %yr6u�v�,Y C�rrt� �� 1I�75 •-a5,� -�'757 <br /> �nvF< -�inNi� * 5� L� / ic/A 58:301 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> /I/�� F_��r � SC. �•n i,��r- �/�� -�53 --S7S 7 <br /> CONTRACTOR �/' • n n / AqORESS /` q CITVIZIP PHONE <br /> {�'Y�n/'c('q��f lf �n•fP�nr��'h ��7301 Sn��'Y'^ �*��' �as - 3n3 - frn7� <br /> CONTR.LICENSE N , , ��n ,,� � �'�F�p.��/ y�a� <br /> !�� l'r�RR �lU6C /= l <br /> USE OF 8UILDING HEAT SOURCE CONTRACT PRICE OF WuRK <br /> �� 5 �`y����� � ✓�leclric _Gas_Olher �' �I,'�j�U <br /> WORK DESCRIPTION <br /> (/�/7?c- /S h `�c'Cl I -��� p �q� � � C�����°,S P <br /> ( <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ��" Toilet A/C—airhandlingunils <br /> �` Bathlub / Forced air syslems <br /> � Lavatory(wash basin) Gas piping <br /> Shower T Waler healer <br /> 1= Kilchen siMc&disposal Gas tireplace <br /> Dishwasl�ar Gas rango <br /> Clolhes washer Clothes dryer <br /> ;� Waler nealer � Range hood <br /> Sink(survice/bar/mop/etc.) � Exhausl fan <br /> Backflcw preventer Fleal pump <br /> Uriral Unit healer <br /> Urinking Fountain Boiler <br /> Floor drain Re(rigeralion <br /> Grease Irap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify lhat I have read and examined this applicalion and know lhe same to be true and correcL All provisions of laws and <br /> ordinaces govemin�this type of work will be complied with whelher specified herein or noL Tho granting of a permit does not presume <br /> to give authority to violale or cancel the provision ot any olher ste;e or local law regulating conslruclion or Ihe periormance o( <br /> conslruction.That I am�uthorized by the owner this property to perform lhe work(or which applicalion is made and I comply wilh the <br /> Slale Contraclo/rs,e�''�18�.2 RCW and 296. WAC. <br /> � (( ?/ _1� 1 '.-?%%�;'(% 3 -'S I_C"��-, <br /> Signalure o/OwnedContractodAuthonzed Agent Date <br />