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I <br /> PERMIT 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 /> J�'Z' APPLICATIONS ARE ACCEPTED FROM 8 AM TO A PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT p <br /> ,wt-�E c�e..� w� 2�oY240020�� �� SD o -0 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CfTY21P PHONE <br /> S«�� Po.�.�� (�uz� LLC �(06 .Ell,;.,ysok R�l i'qaF� `�� °Y7 <br /> TENANTNAMIE CONTACTFORPERMIT PHONE'3E[.�- C�,2,C(- �325" <br /> G�ewt C ��� s Qt�l� LY``c � e.Ma� b�'ll�weyerS'gu.ca �y <br /> ��-ll—.S c�ti .{- }��u J�,��'b�'� 2l�� Nw Y 4 4 5°�-I�l c�82�3 �,(� (�^�'r <br /> CONTR.LICENSE# fu��SA'�3gQ� �'"la{TU�.,,�K �"'-�TS.`113�'� <br /> USE OF BUILDING HENT SOURCE CONTRACT PRICE OF WORK <br /> �U�'^^-"�`��'� �Eleciric _Gas_Other � � ��Ve�_ <br /> WOF.K DESCRIPTION �� <br /> i�;��.,� I lN� s�;:�� ��Gc�u,�- c��P s <br /> PLUMBING MECHANICAL <br /> N0. 7YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Ga,piping <br /> Shower Wa�er heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heator Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backtlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other_ <br /> CITY OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and ezamined this application and kncw ltie same to be Irue and correct. All provisions of laws and <br /> ordinaces qoverning this type of work will be complied with whether specified herein or not.The granting of a permit does ,ot presume <br /> to give authority to oiolate or cancel�he provision of any other state or locai law regulating conslruction or the perlormance of <br /> cons�ruction.That I am authorized by the owner ol ihis property to perform lhe work for which application is made and I comply with ihe <br /> State Contractors Law 1827 RCW and 296.200 WAC. cy <br /> �u�f ,�� �— � l —Ug <br /> r <br /> Signature ot OwnedComractor/Authorized Agent Date <br /> `1� <br />