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� PERMIT APf'LIC�TIQN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3700 CEDAR STREE'', EVEREI"i, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPL!CATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADURESS , PARCEL TAX I.D.# � PERMIT# I. <br /> ' _JCi � '��ii((:�� 26o4�Z-cn4-o24-00 �/��������� -i�"� <br /> ___,� "_ <br /> LEGAI, LOT NO. � 6LGC TRACT <br /> OE3C. T�T E 'X-<JwFN CG1.JT�t- LOTB <br /> ,�WNER Af1tlR SS ,�ITYIZIP PHGNE <br /> fq' ,c%�9T/bN� Q�.v �oPHEu{ /� 4� �H�`J32 ��'ry2,�.,�yy '�r�C2 <br /> �H�' 206-24�--�Z�'L c5�/�'TTdE 4JF� 9P/�p <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> I�es j�n!»/Gr�9 2oG-325=2553 <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> f1�,�� CGvJSTYr�GfloJ 665� sw R�wo a� c�� �370 - �3�5=�� <br /> CONTR.LICEWSE# �JGn��,.�� 1 �2� C,�jLrzl�-. <br /> PAuAT'L/9B9 h�l'�- <br /> USE OF BUILDING HERT SOURCt I CONfRACT PRICE OF WORK <br /> �./<J2E//�USE _Electnc �Gas__Other I ,rJ� �%�j��1-- <br /> WORK UESCRIPTION l � V <br /> L�a.�Sf��Lc�oF SHEt� �r/�1n-ENb"� Gf �G / �'Zi SP2/.c�lr,LEl� 1�5f. <br /> o�' Arx�� � 98,c�o Sr A�v Hssac�q7� .5i� }./qe.r�. <br /> PLUMBING MECHANICAL <br /> NO. TYFE OF FIXTURE OR ITEM ',JO. NPE OF FIkNRE OR ITEM <br /> � Toilet A/C—airhandlinguni;s <br /> Bathtub _ Forced air systems <br /> Lavatory(��ash basin) Gas piping <br /> Shower � Water healer <br /> Kitchen sink&tlisposal _ Gas fireplace <br /> ' Dishwasher Gas range <br /> Cbthes wasner Clothes dryer <br /> � Laundry tray __ Ranye hood <br /> Sink(service/bar/mop/etc.) Exhaust tan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> _ Dnnking Founta�n � Boiler <br /> Floor drain Refngeretion <br /> Greas3 trap _ Woodstove <br /> Foof dreins Other <br /> Other <br /> I CITY OF EVERETf LOCAL SALES TAX CODE IS J105 <br /> �' I hereby ceritify lhat I:iave read and examined this application and kno�v the same to be true and rqrrect All provisions of laws and <br /> i ordinaces governing Uiis type o(work will be complied witn whether specified herein or net.The granting of a pertnit does rot presume <br /> to give authority to violate or cancel the provision of any olher state or Iecal Iaw regulating consWction or the perfortnance cf <br /> consh�c;,o at I am ;uthorized by the owner of this property to perform the worlc for w::ich applicatlon is made and I comp'y wich Ihe <br /> Stat Cont rs Law 18.27 RCV�and 296.200 WAC. <br /> � i s� r�(� � . Q'-�- _ � � <br /> � S nature of Owner/ConVa.;or/Authorized A_ it Date j , <br /> L�_. _ � <, <br />