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Oct 20 OS 12: 31p Rrea 2066221117 p. 3 <br /> r <br /> � PERMIT APPLICATION <br /> i 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 �O 'o�y �� <br /> S�TE ADORE55 � PARCEL TAX I.D.N PERM17 A ' <br /> //2/5 - /�S. �Y� S'� 0057��00/00302 I - �, <br /> IEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYRIP PNONE <br /> s��'L.�.�E ��C'•G.G.G. �� ��i.+J rT-. s�--�-�2t C�cf 6 zz aos�y <br /> ruiss...r-G�a•✓ <br /> TENANT NAME CONTACT FOR PERYIT � � PHONE <br /> /N�/t I /KiLG�/�"�G. L..yti� s C2c,6 \ tJ3�— �7�0 <br /> / <br /> CONTRACTOR �� �5�,.��G� ACDRE55 CITYRiP PHONE <br /> �>'S�6 5��� • <br /> CONTR.LICENSE� ��c- �G.� �3��� /3/ sl�a . ZKwrc,g- �0 6 ���-y���� <br /> — _ _ �� I <br /> 0 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> N.+�' ��' <br /> Electnc Gas Other � <br /> NORK DESCRIP7101� � � <br /> /.��i2sau �ju,.1 ,�e`r+iT f�G �Xis7�v�- uc�v�g. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FU(TURE OR ITEM NO. TYpE OF FIXTURE OR ITEM <br /> _ Tailel A/C—air handling units <br /> _ Balhtub Forced air systems <br /> __ Lavalary(wash basin) �as piping <br /> ,_ Shower � Waterheater <br /> � _ Kilchen sink 8 disposa� Gas fireplace <br /> Dishwasher Gas range <br /> i _ Clothes washer _ Cbthes dryer <br /> Laundry tray Range hood I <br /> I ` Sink(servlce/barlmopletc.) = Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit healer I <br /> I = Drinking Founlain = Boiler i <br /> � — Floar drain I <br /> � Grease trap Refngeration <br /> I — = Waodstove — --- <br /> Roof drains Other_ <br /> Other <br /> I <br /> I <br /> � GT!OF EVERETT LOCAL SALES TAX CO�E IS Jti05 I <br /> I� I hereby reritify thal I havc read and examinud fhis application and know the same to be Irue ar.a correct Ail provisions of laws and � <br /> ordinaces goveming this type of work wil!be complied wilh whether specified herein or not.The granting of a permit does not presume � <br /> lo give authoriry to violate or cancel t�e prov�sion af any olher slafe or local law regulating mnstruction or[he peRormance of <br /> conslruction.That I am authorized by Ihe owner of this property to perform Ihe work for wbich applica6on is made and I comply wilh Ihe <br /> I State Contradors Law 1827 RCW and 296.200 WAC. <br /> I <br /> I I <br /> i Signawre of OwnerlContracror/AulhonzeU Agent Date � <br /> I i <br /> � <br /> � i <br />