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� PE�MIT A;PPLIGP�fION <br /> CITY OF EVERE7T PERMIT SEit'v'�CES <br /> 3200 CEDAR STREET, EVERETT, WA 9U201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PIN �J -a 6 -0 6 <br /> SITE ADDRESS l0�ji1� l at h��L h� PARCEL TAX I.D.# /f�ERMIT p� / <br /> S11�1'CG ZOZ {� ?AYl OOS�.JSOo000Z� /� `� Q1 � <br /> LEGAL LOT NO. BLOCK TRACT <br /> oesc. _. stiE AT �— <br /> OWNER ADURESS �EV�CR�- P¢25 ( <br /> Or. GNAFZI�b K�M 400¢ cor.sY AvF qszo/ zsz-a�2� <br /> CONTACT FO{i PER_MIT PHONE <br /> TENANT NAME L0121 SH�Bf1 �S <br /> pr- GNpltt-Ss K�r'1 o�csw�PS.ING. q52. 5393 <br /> CONTRACTOR ADDRESS CITYRIP PHONE <br /> WR, flphldsoK, ING. /25/O i3o'�'Lane �1�2KLpNb 4-25 67¢rf <br /> CONTR.LICENSEk �"IGK Kr/HN Iu-� QS03�- S2i� <br /> c��.N�x z5 i e! <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ,� (vT'r �� ) I _Clectric _Gas_.Other r � ��p� o= <br /> WORK DESCRIPTION <br /> co/15-Yvuc-Y �'tnaN'�' rmPra�/eN'�owts -}br a /• �'/9 '�.F- Uen1A/ o i� <br /> � ;nisnes, e/ecfYieal <br /> incl�i„9 �vrter�or parr�'f?ons� ¢yu prvieKt, f <br /> �.di vi'n9 a„A lrg hi'i Kg . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM <br /> N0. TYPE OF FI%TURE OR ITEM <br /> 2 Toilel _ NC–air handling units <br /> Bathtub _ Forced air systems <br /> 2 Lavatory(wash basin) _. Gas piping <br /> Shower _ Waterheater <br /> Z Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> � Clothes washer _ Clothes dryer <br /> Laundry trey _ Range liooa <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer __ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Foun:ain _ Boilec <br /> Floor drain _ Refrigeration <br /> — Woodstove <br /> _ Grease trap Olher <br /> Roof drains — � <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify tliat I have read and examined lhis application and know the same to 6e true and correct. All provisions ot laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The granting of a permil does not presume <br /> to give authonry to violate or cancel the provision of any other state or local law regulaling construction or the pedormance of <br /> construction.That I am authorized by the owner of this property to peAorm lhe vrork for which application is made and I comply witb lhe <br /> State C lrectors L 18.27 RCW and 296.200 WAC. <br /> �—�� - 3 3� ��� � � <br /> Signatu of wnedContractor/Authonzed Agent Date Z <br />