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PE��MIT APPLICATIOIv <br /> CITY OF EVERETT F'ERMIT 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 5 _a�.-0 7 <br /> SITE ADDRESS PARCEL TAX I.D.# EMRMIT N <br /> �c7 �7 �dG� �" /C�� - �lv <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANTNAME �7��'�= M�`—R�kF�� ' I CONTACTFORPERMIT PHONE <br /> �t d�:v�� G, �t s��� e /M/'RE SA.�IK�.s 7 6 a- Y U_ z6�� <br /> CONTRACTOR'1 /� _ _� AD�RESS C�1Y21P PHONE <br /> J�b�� l.ri`nn <br /> CONTR.LiCENSEp P�aN�c.?C9�Sy�a^ 30Y/�/ $�' i� N�� �,G.L' �'�'6�v.G (,�/� 9Q22 � <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> _Eleclric �Gas_Olher I 'Z�, Q v� <br /> WORK DESCRIPTION <br /> /n�r� �� N,�'rv G�u.,�fcr� , /��z:w lv.l�k'-�.v Gw�.i-"2 , <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITE�JI NO. TVPE OF FIXTUNE OR ITEM <br /> Toilel A/C–air handling unils <br /> Balhlub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower aler heater <br /> Kilchen sink&disposal Gas lace <br /> Dishwasher Gasrange <br /> --�lolhes washer Ciolhes dryer �` <br /> — Wai�Nae�r Range hood <br /> �i Sink(service7bedu�op/elc.) _ Exhaust fan <br /> _ Backflow prevenler_ Heal pump <br /> Urinal � _ Unit hoaler <br /> Dtinking Fountain Boiler <br /> Floor drain Refrigeration <br /> _ Greaso trap Woodstove <br /> Roof drains � Olher�,iaGK-/,t, GJ.tt2 <br /> � Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerility that I havo read and examined this application and know lhe same to be true and correct. Atl provisions of laws and <br /> ordinaces governing this typo of work will bo complied with whether specifiod heroin or nol The granting of a pertnit does nof presume <br /> to give authonty lo viotate or cancel the provision of any other state or local law regulating wnstruction or the performance of <br /> conslruction.Thal I am authorized by lhe owner of this property to pedorm the work for which application is made and 1 comply with the <br /> Slale Conlractors Law 18.27 FCW and 296.200 WAC. <br /> �� -�..�' r�� <br /> Sign ur ti Owned oMractor/Aulhorized Agent Dalo <br /> fl2 <br />