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PERMIT APPLICATION G _13_06 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 425-5708 10D FAX 425 257E885RE wwwe e8ettwa.org n �.1� V��(�-� I � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �p��y-��3 <br /> SITE ADDRESS PARCEL TAX I.D.N P R.� MIT K_ <br /> c�.e -f-nvT ST � S 2250 G G �� <br /> LEGA l� T NO. BLO� TRACT � � ���J � <br /> OESC. �� <br /> OWNER ADDRESS CITY215�21� PHONE <br /> ��u�Vif.� CG'n4c�C�4orG �� l`�Gx ,�G��� EVc/eH- ��ZS"'F'i70 - �.2Y � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR �AMC �S, A��e ADDRESS C�iY21P PHONE <br /> CONTR.LICENSEItC�� M �CL (SI � "C <br /> •J <br /> USE OF BUILDING HEAT SOURCE I NTRACT PRICE OF WORK <br /> � F (� _Electdc �Gas_Other I `� I 3 Gj G��U _ <br /> WORK DE5CRIPTION <br /> � <br /> � ,(�� / � ���� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilot AIC—elr handling units <br /> Balhtub _� Forced air syslems <br /> � Lavatory(wash basin) � Gas piping <br /> Shower � Watarhealer <br /> � Kitche�sink 8 disposal Gas fireplaco <br /> � Dishwasher I Gas range <br /> 1� Clolhes washer T Clothes dryer <br /> .twater � Ranga hood <br /> Sink(sorvice/bar/mop/otc.) _ Exhausl fan <br /> Backllow preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Reirigeralion <br /> Greasa trap _ Waodsteve <br /> Rool drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I heroby ceritily Ihat I have road and crxamined this application and know lhe same lo be lrue and correcl. AII provlsions of laws 2nd <br /> ordinaces poverning this typo of work will be complied with whelhor specified herein or not.The granling ol a permit does nol presume <br /> to give authority lo violalo or cancol Iha provision of any other slate or local law regulating conslruclion or the performance of <br /> conslruclion. Thal I auth i by tho owner of thls propeAy to perform lhe work for which applicalion is made and I comply wilh the <br /> State Contra nd 29fi.200 WAC. <br /> /� �I'JU ��, <br /> SignaWrn o 0 oMractor/Authorized Agent Date �/� <br /> � <br />