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P�.RMIT APPLIGATI(,,�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDP.R STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 4?_5-257-8857-www.everettwa.org <br /> s- ��-�5 <br /> APPLICATInNS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS I d3 I S - I�1771 A-vC- S E ppRCEL TAX I.D.# P RMIT# � <br /> S i'E !0.�, , E.uG-R.E'tT� wA �18 208 '��'� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> WNER ADURESS CITY2IP PHONE <br /> f�' t�FVGWN�"t�^'� p` 67,25 _��6'77-4fWE NE � Si� 1o0 4Li- 922 - 4�}66 <br /> LV ASSUC.lRTE3 � LLC I-CIRKLN�NI� WFl cl$053 <br /> NANTNAME I CONTACTFORPERMIT PHONE <br /> � (LVF,2 CR-EEK DENTAL � �E�tN �H-nIC� i{.,ZS - 22a -SS 3S <br /> VtSioN GA�= <br /> CONTRACTOR Q�GH OV"j'T`R�y ADDRESS CITY2IP PNONE <br /> cA��c C2EE�- c�UIWc2s j 63�'7 ShwKEY Po(NTg�✓D NtFie%svl«C (�LS - 33o _ <br /> CONTR.LICENSE# ���Lr �q 7�BZ � `at7 - �7 W A `i�.271 6 7 83 <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> j�,�.177�L a- V I �IpN CPc�-c Electric ��Gas Other c� � �"j� 000 . UO <br /> WORK DESCRIPTION <br /> �utJS'-u.uCn`�lo�J o� �sT'�c,cNs k �JALI. PA+'L"t1l lon�5_ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR fTEM <br /> Toilet A/C-air handling units <br /> r Bathtub Forced air systems <br /> �� Lavatory(wash basin) � Gas piping <br /> Shower I Water heater <br /> i Kitchen sink&disposal � Gas fireplar,e <br /> ' Dishwasher ,� Ga�:rar.ge <br /> Clothes washer i Clothes dryer <br /> Laundry trey D Range hood <br /> Sink(service/badmop/etcJ _� Exhaust fan <br /> Backtlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain � Refrigeralion <br /> Grease trap C Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OP EVERE7T LOCAL SALES SAX CODE IS 3105 <br /> I hereby ceritiy that I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces ga�erning this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other stale or local!aw regulating wnstrucGon or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with lhe <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> -G��;h ��T s 3-5 <br /> Signature of OwnedContraclo uthorized Agent Date <br /> �/z <br />