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�- <br /> PEKMIT APPLICATION <br /> CITY OF EVERETT PERlVIIT 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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERIhIT# <br /> � � � La,.tib�_�cl avt � �U�13 clU 7`�� G�'� GG I c_�9- 9 <br /> LEGAL LOfNO. BLOCK TRACT <br /> DESC. C �7 �- u 7�I I <br /> �� � <br /> OWNER ��,�,i� V:�v C��na-r<:� . or� ��C_ ADDRust3cir :�043 £ CITYIZIF PHONZS� E'7U- ].2NI <br /> „�-crf 9Ezt3 / <br /> TENANTNAME I COMTACTFOR PERMIT PHONE <br /> CONTRACTOR` A DRESS CITY2IP PHONE <br /> Sc�v�c�v. �• Cc�tii-fcC�Ecr$ LLC �U. aCi�[ r�0 ''(3 �UerLt�� `Y�113 �(25 � �'7U• 7�Z�/ � <br /> CONT .LICENSE# <br /> �CC�ncl C L `15 l �C GC <br /> USE OF BLIILDING HEAT SOURCE I �ONTRACT PRICE OF WORK <br /> S � � I —Eleclric �Gas_Other � �S� ��C' <br /> WORKDESCRIPTION �� �Pr,' 1� �cS �c� ��� <br /> ��, ( c� e�e+ Ac�.�r( S:,�g � <br /> �j�G�l C� ��o� <br /> -- PLUMBING MECHANICAL <br /> �;p, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> - i <br /> � Toilet FVC-air handling units <br /> %�,T Balhlub I Forced air systems <br /> _,� Lavatory jwash basin) '_� Gas piping <br /> Shower � Waler heater <br /> � Kitchen sink&disposal / Gas fireplace <br /> I Dishwasher I Gas range <br /> �_ Clolhes washer I Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/elc.) � Exhaust fan <br /> Back(low prevenler _ Heat pump <br /> Urinal _ Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drzin _ Refrigeration <br /> Grease lrap _ Woodslove <br /> _ Roof drains , _ Other�_ <br /> Other — <br /> ICITY OF EV�RETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceri(ify thal I have read and examined this applicalion and know the same to be lrue and correcl. All provisions of laws and <br /> ordinaces goveming lhis lype of work will be complied witl:whether specitied herein or not The granling o(a�ermit does not presume <br /> to give authority lo violale or cancel the provi;ion of any other slate or local law rec�ulaline�construction or lhe pedormance oi <br /> construclion.That I arp aulhorized by the owner of this property lo perform the work for which application is made and I comply wilh the <br /> Stale Contractors Caw 18:�7 RCW and 29G.200 WAC. <br /> � f-' �f- � US <br /> i : ii <br /> /�>G�"j�i--- <br /> Signalure o(OwneriConlrector/Authorized Agent Dale i <br /> �L <br />