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P�RMIT APPLICATIC�N ,�o <br /> CITY OF EVERETT PERMIT SERVICES �� � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 l,1 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM 70 4 PM <br /> SITE ADDRESS 11 I O� '�.�t�t. �r22-v� • PARCEL TAX I.D.if PERMITf <br /> -C v��� �� �1 2c% SDc.e ll—no <br /> LEG LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER,�� /E�--CTI'�1`1y T�Lv��t LLC.DRESSZSz � /ZlIG�C'2�,+IVE-� PHONE Z�� <br /> V z-ve�.e�G w� R g�� 339� 3 �38: <br /> 7ENANT NAA'E CONTACT FOR PERMIT PNONE <br /> ZGIJ - �`� LLG �� i' NC�uv��c/ (2oG� S5� - 1� 4 �1 <br /> CONTRACTOR -��� ��uyE� ADDRESS ITY21P PHONE <br /> 2�•� I t3�. t2�•� �ta.�,.�, �`?6�6 � <br /> CON7R.LICENSE# �] � � �� w w q �� ,� � S O� IZ 4 <br /> i L <br /> USE OF BUlLDING HEAT SOURCE �ONTRACT PRICE OF WORK <br /> / � <br /> _Electric _Gas_Other � 5 �, <br /> WORKDESCRIPTION M�N�L_ �-�rL �- ,.��� 2�C � `� � <br /> � <br /> �,�..,� ;,�g-E�..�-�. . � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE QR ITEM NO. TYPE OF PUCTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wa. •in) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 c sH�sal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Si�k(service/bar/mop/etc.) Exhaust fan <br /> BackFlow prevenler Heatpump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Retrigeradon <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Ottier <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritiry that I have read and examined this applicaGon and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That 1 am authorized by the owner of this property to perfortn the work for which applicatlon is made and I comply with the <br /> State�a Law 1827 RC�j d 296.200 WAC. <br /> � �C�-"- I - b <br /> SignaWre��'OwnedCo tr tor/AuthorizedAgent Date ,1,2 <br /> � <br />