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" --�, — <br /> PERMIT APPLICAYION <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 <br /> SITE ADDRESS PARCEL TAX I.D.# PE IT# <br /> o933-i9TM ve.56. �.lol Ol 0301v Q9D 101 Oo _� �S' <br /> LEGA!. LOTNO. BLOCK TRACT <br /> DES(:. 1 1.����� <br /> OWNER AUDRESS CITY2IP PHONE <br /> gL�1 As�e�,►,�s, LIC. -1oh?� -�38"' R..ae6 9o�miwesr, ���s. w�. 98o2e <br /> TENANT NAME COh;aCT FOR PC•RMIT PHONE <br /> MoOeRN �MA'bf. K�N �1r+H�N � Caa� Mas�u 2dv t�23 -3tw _ <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> He�-ru N�acn+wss� �27 S. 9�-� 9-r. � SEA-nc.E,w,a. 96►oe �1.ow �023 -3wn <br /> CONTR.LICENSEt ���N=9813� -g/sl�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> V6N�.Q� ���.� _Electric _Gas_Other � ` �� �� <br /> WOkK�ESCRIPTION <br /> SN�TAU..ATont oF �l� NEW gE7 6F l4u TAu.. CiiA�NNEc. t.E.'T't6R5i� <br /> � GWhNNE�. 4VteCD Eox - To R�,sa '� MooE� �MAt� 34�N��• <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Cbthes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> Backflow preventer Heat pump ' <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain � Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY 9F EVERETT LOCAL SALES TAX CODE IS 1105 <br /> 1 hereby ceritiry thal I have read and examined lhis application and know the same to be L•ue and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whelher specifed herein or not.The granting of a pertnit does not presuma <br /> to give authority to violate or cancel the provision of any other state or local law regulating construclion or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work tor which application is made and I comply with the <br /> State C ntractors Law 18. 7 CW and 296.200 WAC. <br /> V v, <br /> � nature of Owned t r/Authorized Agent Date <br /> � � � <br />