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PrRMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT 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.# PERMIT# <br /> r� a� �zZ3c2��sG� M 7oq - � � <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> Eocti�.� �����rr� l��-r G�*fd � �� �25-339-Y�aB� <br /> TENANTNAME I �NT�RPE� y25E���y�y <br /> C[-/� e-nea� <br /> . TRA <br /> D�' d-n/iT� P�meG- �-r�'rG ��Gi�� �3 �( �.� 9t�3�7 `(z5-7�S�y1//' <br /> CONTR.LICENSE#^^�- }�.p�O��C � A - <br /> 1� /��.J— �" \ <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric �Gas Olher � �7/S✓7.� <br /> WORKDESCRIPTION R�.o�cE �,X�$j�/V(� �S ��AG� l�� N'�� <br /> �i`LS -�-L11�lJ�►cE _T-n� S�r'✓L'e- 1lJe�9'f iOJJ • <br /> ( PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ItEM <br /> Toilel A/C-air handling units <br /> BalhWb �_ Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clolhes dryer <br /> Water healer _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floordrain _ Refrigeralion <br /> Grease lrap _ Woodstove <br /> Roof drains _ Olher <br /> Other — <br /> C�TY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify thal I have read and examined lhis appl�calion and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this lype o(work wiil be complied wilh whether specified herein or nol.The gtanting of a pertnil does not presume <br /> to give authority to violate or cancel the provision of any other slate or local law regulating construclion or lhe performance ot <br /> conslruction.That I am authorized by owne f this property to perform lhe work tor which application is made and I comply with lhe <br /> Stale C hactors Law 18. CW n 296.200 AC. <br /> ' g��� <br /> SignaMr o wnedContractor ze ent Dale <br /> � <br />