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; <br /> �- PERMIT APPLiCATION <br /> CITY OF EVERETT �'ER,MlT 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 I D 33 3 �q A.t�- S L PARCEL TAX I.D.# PERMIT# <br /> cvc,�ct1� �a gg�o� 005 �) 5 5 �0000moo �' 90� ? - <br /> LEGAf. LOT NO. Q BLOCK TRACT / , y- <br /> DESC. [P � � � 1 V UL g 51 � ✓Fi( l.-GL.K-e. v'�2'lV r0.Gl .S <br /> OWNER ADDRESS CIN21P PHONE <br /> P.o. (�ox , acg � n.�;�l C,-�k c._,a ,�,�R <br /> F�.l(� LLC q5cc�scz <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> N I.� A sf�•�•�. ', F�ll er �� �'eSse Y�lo,T1-e2 �205) ���6 - `1 a$`d <br /> CONTRACTOR ADDRESS CITYIZIP PiIONE <br /> rno..�'� .�wld ►'�.,tl e.r --i7� � '�e�'�t A�2 s w �.?�x) -il�Sf - 4a�8 <br /> CONTR.LICENSE# SP°"�"�' 1 �"�A q�G�/O�o i <br /> v�n�c.00Fs SBo6Zu i2 -3r-o�l <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> � /,�' \ �/ <br /> C�M yu/,�C(„� '"�-c C/�• �Eleciric _Gas_Other � �J (�� t q I ^ <br /> WORKDESCRIPTION •t-0.�k wi'}� ho� W�fi YCG+'G�Iu.'}'�OI� <br /> �.G�CS` � �i�.QiC.�'Yi C �'�v'�' t.Ja.'�'P.V <br /> Qwmp � 2X(��.n4lOn �c..wK � Adt� I �o..ni�'or S/r� I� � 0.c��' � a SIn�C$� <br /> 0.dc1i o1 -�'o �le�-s � 5-�-�.,.b ou-k- .�i'sr � d�shwasher , 1 �v�nki;�9 Foun c.i � <br /> PLUMBING MECHANICAL ' <br /> NO. TYPE OF FIXTURE OR ITEM N0, TYPE OF FIXTURE OR ITEM <br /> � Toilet _ A/C-air handling units <br /> BathWb Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal _ Gas fireplace <br /> 1 Dishwasher Gas ranye <br /> Clothes washer Clothes dryer <br /> Laundry tray Range nood <br /> � Sink(service/bar/mop.�tc.) _ Exhaust fan <br /> E3ackflow preventer _ Heat pump <br /> Urinal Unit heater <br /> J_ Drinking Foun�ain _ Boiler <br /> Floor drain _ Refrigeretion <br /> Grease trap _ Woodstove <br /> Roof drains _ Olher__ <br /> � otner I%�o_1' iv�-''rei "ra�k _ <br /> � TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined ihis application and know the same lo be irue and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher specified herein or noL Th=grenting of a pertnit does not presume <br /> to give authoriry to violaiz or cancel the provision of any other state or local law regulating consWction or the per(ortnance of <br /> coostruclion.That I am authorized by the owner of this property to perform lhe work for which application is made and I comply wilh the <br /> tate ntr ors Law 1827 RCW a G200 WAC. <br /> '�J��- �!�— I I �O`7 <br /> —Si� �vner/ConiractorlAutho gznt Date <br />