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-� <br /> PERMIT APPLICATION <br /> ClTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �,. _ 13 —0 7 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM SG/"f l D`J��D O <br /> SITE enDRESS ' PARCEL TAX I.D.# PER IT p <br /> > � y/ <br /> ���`� Q�ij'J(,!'J�J �a3 v�v0000�ioo `�o� �Sozt c,� 7 - <br /> LEGAL LOTNO. BLOCK TRACT � ,p �/ ,p <br /> oEsc. � G2-y3- '7619-f v F,.25x_Q -v YrR-�� .LUT d � f'�tcn �'NtPi/ ��- <br /> OWNER ADDRESS CITYIZIPy&.���PHON <br /> �o�,� rNEy �o�2r LLC �,�Go� •H�ar� �e .S� /n�u.Po.:.- CcJA� ¢2� •359- 6�L <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> � �lfHRtES MDQLA/J �/2D-353—�BSg <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> SlA1GLG !'/t����y ��NNomC _Electric � Gas_Other �L� p0 D <br /> WORKDESCRIPTION Cd/D'SY2LCf �S d�'UGLE !—A�M/LY TOtuN�7�BS �j}�2L� lo <br /> �.s� c, -Toumhats� w���n-� - 7y� _2 <br /> PLUMBING MECHANICAL <br /> NO. 7YPE-GF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel ,� A/C—air handling units <br /> 1 CiathWb � Forced air systems <br /> _� Lavatory(wash basin) �} 7a Gas piping <br /> Shower � Water heater <br /> � Kitchen sink 8 disposal _L Gas fireplace <br /> / Dishwasher �, Gas range <br /> � Clothes washer / C�othes dryer <br /> _ Laundry tray � Range hood <br /> Sink(service/bar/mopfetc) 9� Exhaust fan <br /> Backilow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br />� _ Floor drain _ Refrigeralion <br /> Greasetrap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify tha� I have read and examined�his application and know the same to be true and correcl. All provisions of laws and <br /> ordinaces goveming this type of work will be wmplied with whether specified herein or not.The granting of a permit does nol presume <br /> to give authorily to violale or cancel the provision o(any otlier slate or local law repulating conslruclion or ihe peAormance oi <br /> construction.Thal I am authorized by the owner of lhis property lo peAorm lhe work for which applicalion is made and I comply wilh the <br /> State Contractors Law 18.27 RCW and 296200 WAC. <br /> '� v� S� �� Z3 hP2 07 <br /> Signature of OwnedCont orlAuthorized Agent Date <br /> �-- Y <br />