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PERMiT APPLICATION <br /> CITY OF `VERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> �3-a i�� g�iaa�n� �t-1c£� C,� , „ -,��cr.a' r,r � rC•r � 70�'C�I�" <br /> LEGAL LOTNO. BLOCK TRACT n � <br /> DESC. �`���� . C�'�Q YC�- , J1 Y I�SI�11 , � <br /> OWNER AODRESS CITY/LP PHONE .�-��j _,1��- <br /> �vetittl C�A�C'��Ct�� Cflller LLC., 2� i� QocK�t'�lle� Ave , [�crr-H- ��;201 .�-a►o <br /> TENANTNAME CONTACTFORPERMIT ^ sI PHONE <br /> (_�' '3c•� -j- Sll1'1 �-�tS(L �.�QCC�`1�, F1t\�['� IC^.Il ry�01� Liai (01� -�44{s <br /> CONTRACTOR ADDRES C TY/ZIP PHONE <br /> Ar�, ;,.a�� Nao►� (ne� , �02 39+h Que C Su� Lake.u_ 9P�►� a53 to�� -���ti{,. <br /> Cf1NTR.LICENSE tS <br /> AM[�It�1�002.n�. <br /> USE OF HUILDIN6 I — HEAT SOURCE I CONTRACT PRICE OF WORK � <br /> M�IN=� - ;e ncini � '' <br /> re�tl� I Elednc Gas Other �� -� �'�� '�.-' `—� <br /> WORKDESCRIP710N j(��-p�� �,�'���.�1(�(,�a� �n{(��1��L��L ���Iti1Ll�1�(�C�� <br /> e ������� �.�►�,-� , v��o���1�c� � �.n ���e► �c� a����u����v <br /> rae��c�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE nR ITEM <br /> Toile� A/C-air hendling units <br /> Bathtub , Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(sercice/badmop/etc.) Exhaust fa� <br /> BackOow prevonter Heal pur ip <br /> Urinal Unit he�ater <br /> Drinking Fountain Boiler <br /> Floor drain Refngeration <br /> _ Grease trap Woods�ove <br /> _ Roof drains = Other �' � I�i _ <br /> Other <br /> CITY OF EVERETt LOCAL SALES TAX CODE IS 3fOb <br /> �hereby ceritiy that I have 2ad and examined this�ppliwtion and know the same to be lrue and corred. Ail provisions of laws and <br /> ordinaces governing this type of work will be comptied wlth whather speafied herein or not.The granGng cf a pemiit does not presume <br /> to give authority to violate or cancel lhe provision of any other slate or local law regulating construdion or the pertormance oF <br /> consWdion.Thal I am authonzed by lhe owner of this properly to perfortn the vrork tor which applicatior is made and I comply with the <br /> ont2ctors w 18.27 RCW and 296.200 WAC. <br /> r <br /> -,� �� L�; �� � . -,-�- <br /> Ignature o ner/ ontreaod ut onzea Agent ate r�` <br /> �---- � <br />