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�ERMIT APPLICATION <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 /� ��U�-�� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 7/a �s oosi7 0 00 �'� i�'�_ <br /> LEGA LOTNO. BLOCK TRACTORSUBUIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> f �e 5� sNo r�oM�s I+ y�,8 7G`0 87� <br /> //�A� NuTCFt�n150�..J alb0,2 /,20� 98a-`1C� <br /> TENANT NAME I CONTACT FOR PERMIT �y'cE���6(�G y <br /> /�ATN�r GU�So,..� ��`�� ��r� EMAIL <br /> CONTFiACTOR A�ARESS CITY2IP PHONE <br /> Dav a-�l,r� Gr�r��-�- h'-r�y �G�/y �3�Aue- �v L.Y�(Nu�c+�D �2�775-�yG <br /> CONTR.LICENSE# 90v3� <br /> USE OF BIiILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleciric �Gas_Olher � ��73y•�l`� <br /> WORKDESCRIPTION f?EPGAc�_ �iSTi+�� GMPi2� ���� (T�� `��'�L W��{ <br /> A �ew Emo.� CoNso� G,g-5 ��� .�.� -nfe. <br /> SM�t� Lr>CAT70..1 �i7�.Q/J NO N2,u> P�nl <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR I7EM N0. TYPE OF FI%TURE OR ITEM <br /> Toilet _ aC—airhandlingunits <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ W�terheater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Cbthes dryer <br /> Water heater __ Range hood <br /> Sink(service/bar/mop/etc.) __ Exhausl fan <br /> Backflav preventer Hea�pump <br /> Urinal � l!nit heater <br /> Drirking Fountain _ Boiler <br /> Floordrain __ Reirigeration <br /> Greasetrap _ Woodslove <br /> Root drains _ Other <br /> Olher__ _ — <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I he:eby cerility that I have read and examined ihis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces c�overning ihis type of work will be complisd v�ith whether specitied herein or noL The granting of a permit does nol presume <br /> to c�ive authority�o violate or cancel ihe pmvision o1 any other state or local law regula0ny cons�ruction or�he performance of <br /> conslruction.That I am authorized by the owner of this property to pedorm the work lor�vhich application is made and I comply with the <br /> Stale C rac�ors Law 18. RC nd 2(JO WAC. ^ <br /> � Sig re OwnedConiractor/ �ori Agent Iv D� <br /> � <br />