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PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 g�7,�07 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��2� <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT p <br /> 2106 GRAl.ID AV� . 004314'i3102°i00 � �70(�; • �3 <br /> LEGA LOT NO. � BLOCK TRACT OR SUBDIVISION il " <br /> oesc. �='L°I �3C:i� �y 31 4 31 [71U l51�N G <br /> OWNER ADDRESS �1�1 CITY2IP PHONE <br /> �AMES � KRIS�IE I�'1` 1.1E11_ �2415 iZUCKEIZ AVE��VESZETT� 425�25ci=11�2 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> — 3arnEs nn�r,tEi� ti2s ��q � n2 <br /> CONTRACTOR ADDRESS q�,�� CITY2IP PHONE <br /> GREG SKGL�dN , 'Z3633 I1�DWAY PARK RR�W�DDIUAY� WA. i '�1�6�°I19-$4V4 <br /> CONTR.LICENSE# GFSKEFS�111Y.3 � 't�-3 -c,n�� <br /> USE OF BUILDING m�AI_T� FAVYI I L�f HEAT SOURCE CONTRACT PRICE OF WORK <br /> 3 j.���T �-��r�-���N`u� Eleclric ✓Gas Other <br /> WORK DESCR�PTION ` <br /> � . �(HAUE �EII'iD PER � <br /> CI�NS'1RL1GT :3 U IJ IT C.OIJDO�'1�l IJ 1 U1'V� . � oa�o5,o03 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling unils <br /> BaQ�tub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(servicelbadmoplelc.) _ Exhausl lan <br /> BackOow preventer _ Heal pump <br /> Urinal Unil healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined Ihis applicalion and know lhe<ame to be true and correct. All provisions oi laws and <br /> ordinaces goveming this lype of work will be complied with�vhether specified herein or not.The granting of a permit does not presume <br /> lo c�i �authority to violate or cancel the provision of any other slate or local law regulating consWction or the peAormance of <br /> cons ucfon.T �+t I a ut mzed ,� ie owner o(Ihis property lo periorm the work for which application is made and 1 compiy wilh lhe <br /> Slate Co a o s N RCW 296.200 WAC. <br /> .Q IIA��'T1 �-�v-07 <br /> Sig a ur o Ow edContractor/Authorized Agent Date 1 / <br /> /�(: l�Z ��� ! � <br />