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Oct 20 OS 12: 30p Rrca 20662211l7 p• 1 <br /> � . <br /> � PERMIT APPLICATION <br /> CITY OF EVERETT PERMi7 SERVICES <br /> 3200 CEDAR STREET, EVERETT,INA 98201 <br /> 425-Y57-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� � o�L��U <br /> SITE AODRE59 PARCEI rsY I.D,At P RMIT M <br /> //2�7 �.��++.�� . �;E Do 5 7`/.'7.00/00/0�! �S� �, - (v <br /> LEGA LOTNO. BLOCK TRACT � <br /> OESG I <br /> OWNER AO!!RESS CRYILP PHONE <br /> siLv�c. �P �E,✓�'�.c �� «..ir,�ro+✓ r r y�a b-cz• ovig I <br /> G. L.G �-7T�i� G✓.Q-- C � <br /> TENANT NAME CONTACT FOR PERMR — � PHONE <br /> /''�,t}- I /►[/utf�/�.Z U�/t t�[-6 �2oG) d�a' ^'��o <br /> CONTRACTOR hG� ��✓5,7xtr�/j7i+J ADDRESS CT'21P PHONE <br /> �fY�/G Sav7Yj 7+�Ks.-i:�- . <br /> CONTR.LICENSEI �-G� GDL/ /$7,N� ��I �T �G . u'� 2p(o Zy6�YB�SS <br /> n Bi.6 $ <br /> USE OF BUILDING I �� NEAT SOURCE I CONTRACT PRICE OF WORK <br /> N� Eleclnc _Gas_Olher I <br /> WORK DESCRIPTICLN , ., <br /> .aE.�raz�Tio,.� /�E�MiT %� �Y� ss77.�.cs.. ylavr� I <br /> I <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF Fl%iURE OR ITEM NO. TYPE OF FURURE OR ITEM I <br /> Toilel A/C—air nandling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas pipfi9 <br /> ShpWBf �'at¢f�leater <br /> Kitchen sinA 8 disposal Gas fireplace <br /> Dlshwasher Gas range <br /> � Clothes washer Clolhes dryar <br /> laundry Iray Racge hood � <br /> Sink(service/bar/mop/elc.) �haust lan <br /> Backflow preven[er Heat pump <br /> Urinal Unit heater <br /> Onnking Fountaln C�oiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> = Raof dreins �I Olher - I <br /> Olher <br /> IC(TY OF EVERETT LOCAL SALES TA%CODE IS 3fOS _ I <br /> I I hereby ceri�ify Ihat 1 have read and examined this applicalion and know ihe same to be Ime and covect. All provisions of laws aad I <br /> iordinaces governing this rype of work will be wmplled with whether specified herein or not.The graming of a permit does nof presumc I <br /> lo give authariry fo violate or ancel the pmvision of any other slate or Yocal law regulating constmction or the pertormance of <br /> construction.Thal I am authorized by Ihe owner of this property to periorm the work lor which applioation is mada and I comply with the I <br /> , Slale Coniractors Law 1827 RCW and 296.200 WAC. <br /> iSignature of OwneUContrector/Authorized Agenl Date I <br /> ( <br /> I _ � I <br /> � <br />