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- -Zz�'� <br /> P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVIC�S �6� �B�� . <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> I 425-257-8810- FAX 425-257-8857-www.everettwa.org � <br /> APPLICATIONS ARE AGCEPTED FROM 8 AM TO 4 PM <br /> SITE AUDRESS , 1`�1'e jL'/� PARCEL TAX I.D.�! P y�IT^� � <br /> a`fl,� East (�ran�l .�re. �� �o eC�l C-g,53i c,��ioo �Cd,��--,�1j2 <br /> LEGA LOTNO. BLO2CK ,Tt�RACT / 7 -y <br /> DESC. �- li I� J� / �� � %• /� r�� �<,n � nn � lI.PI�,�'� �nC /\/ <br /> � OWNER ADDRESS 3` CITY2IP PHONE !! �5^_ <br /> 111Zr1 � Shiriz eu ierho �e Il•'1 � L,y,v,�,c�c�c�, �''� �- <br /> , ,y � � �J Larcl, l.(,c�v 9�03 � %f 3- y(v/ '7 <br /> TENANT NAME �- / CONTACT FOR PERMITjI ' y PHONF �/ ?�_ <br /> ( i'i )7(��� ' � ��t`�y--I.1/.CQ I'1�I�10 Ft,' <br /> 1 :�Ili��-/ ' --____�_�J _ �2s��=-�G�7 <br /> CONTRACTOR �_�L ADDRESS CITYIZIP PHONE <br /> �' � rC'ync�- cf � � �?S— <br /> ��i)Er /�oinr 5 LLC'. �•���{ ' -�l/ %/� S��Ghpn,iSlt� <br /> CON R.LICENSE � (� ��� ��1�� ,� <br /> 21(�IG2 H� 9�F7 SS t�r�� s.r. (q�;-;;� G.'P. `J�.�qO <br /> USE OF BUILDING_J 1��� /t X HEAT SOURCE � CONTRACT PRICE OF WORK <br /> � Y <br /> �5 � �c/)C -L _E:cctric �. Gas_Other � ��,=1 L�� L7� � . L' 0 <br /> WORK DESCRIPTION 2�7� <br /> A�d� 7-i Gn 0 � C1�uClu'�l ctc��� sso�-y Q��c��7n�� ���T Cui � <br /> i <br /> c�e7ac%���1 ,� C�t r ��u ra� E <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITcM NO. TYPE OF FI%TURE OR ITEM <br /> � Toilel __ AIC-air handling units <br /> � Bathlub � Forced air systems <br /> Lavalory (wash b�sin)✓/� � Gas piping <br /> I ,�_ Shower✓.r � Waterhealcr <br /> _L Ki+uien sink&disposal �_. Gos fireplace <br /> 1_ Uishwasher Gasrange <br /> � Clolhes washer � Clothes dryer <br /> Waler heater � Range hood <br /> � Sink (service/bar/mop/elc.) � Exhausl fan ij/ <br /> Backflow prevenler _ Heat pump <br /> Urinal ^� Unit heater <br /> DrinkingFounlain ___ Boiler <br /> Floordrain _E Refrigeralion <br /> Grease lrap � Woodstove <br /> R�of drains � L Other �� cfc� I q/)]- �"���T <br /> �� Oiher L.,'i i ' _JJd�`i •�.� — <br /> (..TY OF EVERETT LOCAL SALES TAX CUDE�S 3105 <br /> I hereby ceriti(y thal 1 have read and examioed lhis application and know the same to be We and correct. AII provisions of laws and <br /> ordinaces goveming lhis lype of work wili be complietl v+ilh whelher specified herein or not.The granting of a pe�mit does not presum� <br /> to give aulhonty te violate or cancel the provision of any other state or local law regulatina construclion or lhe performance o/ <br /> conslruclion.That I am aulhorized by the owrer o(lhis property to Fer(onn Ihe work for v,n�ch applicalion is made and I wmply with the <br /> State Contraclors Law 18.27 RCW and 296.200 WNC. <br /> . i'' <br /> ,1 , s :;_�, Lir ���rli�. a� ��J�� S_ �-aL <br /> SignalurG�(OwnedContraclo thoriz d Agent �ate <br /> - --�s �a- <br />