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� o �aE - G� <br /> PERMIT APPLICATIUN <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 B AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N P RMIT N <br /> 9i� pac«cc av�. 2�053000zcoioo 7/6 - <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER y����� �Y��-�- ADDRESS CITYIZIP PHONE <br /> H�et�icaL cEt�i�'R 1321 co�t�f AVE . �YEg�ETT g25• 2ro1 •455a <br /> t�o. P�a�C I14� 792p6 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �O�lli7�l�1GE �NE-�L-T7' {-JEVit�l GiP��'l-Of- 42�✓• 2�-��J •0868 <br /> �� ���� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> n�o�zrsat��t c�-��rnt�noN �4-11 '� �e 2°�TM t�- aEc..CEwE 425• 8�5•�JO00 <br /> CONTR.LICENSE N <br /> n.�A�.tot2G Ia1�t�v QJ80d-7 <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> F+o�',yPrCA,I- r-2 <br /> ���� _Electric �C Gas_Olher � �J3����• �O <br /> WORK DESCRIPTION <br /> Mf��R -rc�A�-tr �r.�r-��eMc+t� s��L � �l�nt-i6, a�tc� , <br /> SppCE Of,1 `(NE 'I3PF.�MGE-Sj� � � 'f"F� �fLG(�-1G Gf�f��U�i. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel ' � A/C-air handling units � <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinkin3 Founlain _ Builer <br /> Floor drain Refrigerelion <br /> Grease trep Woodstove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correcL All prc��isions of laws and <br /> ordinaces governing Ihis tppe o(work will be complied wilh whelher speci(ied herein or noL The granting o(a permif does not presume <br /> to give authority to violale or cancel the provision ot any other state or Iocal law regulating construction or the perormance oi <br /> construction. Thal I am authorized by Ihe owner of this property to perform the work tor which application is made and I comply with ihe <br /> Stale Contreclors Law 18.27 RCW and 96.200 WAC. <br /> ��7 �.c �. ID•2rv •D� <br /> Signalure of O��rnedContr�kfi I�orized Agent Date _ . <br /> � � <br /> � �z , <br /> � -- — ------- — — — ` <br />