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PE� :MIT APPLICATIOf� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVtRETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM G���� `.I'Z <br />SITE ADDRESS fI ' <br />�� Q � ��� W� <br />LEGAL LOT N0. �BLOCK <br />DESC. !'jEeSH�E�iTI.O <br />OWNER <br />E6P 13u��1���aX LLG <br />TENANT NAME <br />GS � <br />CONTR CTOR ��� SG�ue�� <br />CONTR. LICENSE t� ���SSI�-dSPN <br />USE OF BUILDING <br />(l3) o fFi csZ. <br />PARCEL TAX I.D. # <br />��`I 13CK <br />TRACT OR SUBDIVISION # <br />ADDRESS CITYIZIP PHONE l�� <br />E�.f YF�'�(1 (��� � <br />��i30 sv;� x-icx�. �vQ.f� qS26y �I3g-I(,� <br />CONTACT FOR PERMIT PHONE (,�Z�j —�%D'(p%O�O <br />G�i��J�(M,� e.Mni�c�ndykG�L01'IRPa��' <br />=nc. zax,b y�-r^qv�w. �y2g�7;�-9y0U <br />`yv�v�wo�l� �.�4aBa3� — <br />HEATSOURCE <br />Electric _ Gas _ Other <br />CONTRACT PRict ur vvvn� <br />��j(� � ;. UC� <br />WORKDESCRIPTION p �10If�7�%n <br />T�r�a�ii-Tw�Prov�-r�r't� -Iv ��nclU�,, lM�v�c�'� 'IVE{2ii r � �l.Ot.�J <br />f�.ew r�l��-es �d vc¢� daxs. ,�Uo c1�a-�o,� ���. <br />NO. <br />OF fiXTURE OR ITEM <br />Toilel � <br />Bathtub � <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disp �al <br />Dishwasher � <br />Clolhes washer \ <br />Waler healer <br />Sink (service/barlmop/etc.) <br />Backilow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />TYPE OF FIXTURE OR ITEM <br />au liandling units <br />Forc air syslems <br />Gas pipieg <br />Water heat r <br />Gas fireplac� <br />Gas range <br />Cloihes dryer ��\ <br />Range hood <br />Ezhausl fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAR CODE IS 3105 <br />I hereby certi(y that I have read and examined lhis application and know the same to be true and correcl. All provisions of laws and <br />ordinances governing lhis type of vrork will be complied with �vhether specified herein or nol. The granting oF a permit does nol presume <br />lo give aulhorily to violale or cancel the provision oi any other stale or local lavr regulating construction or the periormance of <br />consiruction. Thal I am aulhorized by the owner of lhis property lu perfo•m lh work for which application is made and I comply v+ith lhe <br />State Conirac ors Law 18.27 RC`.N and 296.200 WAC. <br />. / � �� <br />�'r� D te <br />Signalure 0 medCont lor/Authorized Agent <br />1�Z <br />