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�c�ii�1'lI1T APPLICATILnI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAF STREET, EVERETT, WA 98201 <br /> 425-257-88�0— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FR.OM 8 AM TO 4 PM �,_ J �—, <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> S"`�O/ 2,3/1> Ur' W�I� EvlRCTr Z�O�Q02002G0700 _ �—n I <br /> LEGAL LOTNO. BLOGK TRACTORSUBOIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> SfAW/a`/ CO.QGORA7L LOT .�C LLC -!j`�3Z /'✓E 9?T/� SiiP.SC� SFF1TTLc' WA 98/IS <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �us)983-s6s� <br /> WGSh�nJaan� A✓�c�nG�c� f� �nna�lx�il M� ��Ldn E-MAIL�JMi�iM �AcI✓<i/P./1C� <br /> L`bRTftA bl�`3`� i <br /> Ad✓Gn�e�J F:c /�/c-�c'c-��a� /� v. 6��x i543 <br /> CONTR.LICENSE# ADUANf�lY966 wUc.d�nv;lle wA 45o7L 925)4a3-so.�� <br /> USE OF BUILDING ( — HEAT SOURCE CONTRACT PRICE OF WORK <br /> � u <br /> ����� Electric Gas Other �� '3�� <br /> WORK DESCRIPTION <br /> �d���� 2 S��r�nKle� he�;ds Fiom a,� cx�s-�rn� l.Je+ SyS�eM <br /> �Je/ NF�A i3 ��yh� hc,Zuid. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTJRE OR ITEM <br /> Toilet AfC—air handling units <br /> Balhlub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shcwer Water heater <br /> Kitchen sink 8 disposai Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler healer Range huod <br /> Sin!< is�rvicelbadmoplelc.) Exhaust fan <br /> Back9ow preventer Haal p��mp <br /> Urinai Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Othe• <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhat I have read and examined this application and know lhe same to be true and correct. Aq provisions of laws and <br /> ordinaces governing lhis type of work will be complied with whelher specified herein or noL The granting of a permil does not presume <br /> to give authority lo violate or cancel the provision of any other state or local law regulaUng conslruclion or the performanr.e ot <br /> constmclion.That I am authorized by lhe owner of this property to qerform the work for which application is made and I comply with the <br /> Stale Contr ctors Law 18.27 RCW and 296200 WAC. <br /> ��1J/1G�7�74n /���(�ti/1 �.�/G"/D <br /> Siynalure of OwnedContractodAuthorzed Agent Dale <br />