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P�RMIT APPLICATIC�N <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.IF ER IT X <br /> �030 GRA►JD AVfi �`4�"7�f--3'72 -o51-eo � v� -�� <br /> 0 <br /> LEGA LOTNO. BLOCK TRACT „ �� <br /> oEsc. /,ors5�,52,53 5M 37Z PLAT OF EVE�tETT D�U�S�o N G vo�."F Pn� "F�1 <br /> OWNER ADDRESS CITY2IP PMONE <br /> G f+R15T'£NSE�1 Zo3a �t uutER tw�.'��h EVFRErr N't5 303 �55 <br /> QNALITy MOMES� Ir.14 qQ��•� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��— l"3- � c.H'R�S'T1CNfCiJ "f'Z$ 2/8 laLZ <br /> CONTRACTOR GHR�S'T�NSE�J ADDRESS CI'tVT'IP PHONE <br /> �Hw�.�ry NonrS.�Na z03o RucKfa AJ��'+ '�S Z�8 18�z <br /> CONTR.LICENSE#GHRIS�HIO'lC(o �q 2�PIT <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> GoNnor.�N�uM.s I _Eleclric �Gas�Olher �,2� /OD�OOO.00 <br /> WORK DESCRIPTION GA,��� <br /> T3v���,.D A SFUE�J VtNT �-on�Don�N�NM I3�a��.D��Jt. wtrl+PqRKING� <br /> n� r- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXiURE OR ITEM <br /> �( Toilet _ A/C–air handling units <br /> � Bathlub _Z Forced air systems <br /> -�� Lavalory(wash basin) � Gas piping <br /> 3_�Shower Water healer GwS <br /> 1_ KitcNen sink&disposai � Gas fireplace <br /> Z DishwashCr� � s range <br /> Z Clolhes washc�r � Clot s dryer e�..�t•�: <br /> ,Z Water heater �� � Range od <br /> � Sink�service/bar/mop/etc^.)� _ Exhaustfa <br /> Back(low preventer _ Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 9105 <br /> I hereby cerilify lhat I have read and examined this application and know the same to be true and correct. All provisions oi laws and <br /> ordinaces goveming this lype o(work will be complied with whelher speci(ied herein or nol.The granling of a pemiil does nol presume <br /> to give aulhoriry to violate or cancel the provision ot any other state or local law regulating construclion cr lhe performance of <br /> construdion.That I am authorized by Ihe owner ot this property lo peAorm the work tor which application is made and I comply wilh the <br /> Slate Contraclors Law 18/.�27 RCW and 296.200 WF ;. <br /> Li/�sZ���C/ C:-�A�=�--�--�x;,�-�s/ .517�OG <br /> SignaWre o(OwnedConUactodAuthonzed Agent Dale �/ <br /> - ----- ---- - - `1'1 l� /�'i�S' S L <br />