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I ono _ L-0 ---- <br />PERMIT APPLICATION <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 />g 'a--09 <br />SITE ADDRESS q 5O q Iq 1 t l AVE SE PARCEL TAX I.D. # PERMIT # <br />F-VME1T WA 9o:z ! U 1 700 3 C) S 4 0O G 07/1 '4fv <br />LEG A LOT NO. BLOCK I TRACT OR SUBDIVISION # <br />DESC. SGE A-1Y�U-IEfl <br />OWNER G(-aV ,C14 ®`- J <br />Or* <br />i G}•1jZ CTAuunraa <br />V SA ! Mrs5-3 E N. T `�t PLE �T. 5°I-A N 41 so <br />TENANT NAME `P T>rR`\J <br />ONTACT FOR PERMIT <br />PHONE (+�S) <br />5�6- I136 <br />-ACILIiiCS MANGCEIQ-v <br />FnAnn <br />t to r0'Q1A <br />(NG. � <br />.�� E-MAIL i-'y5l. [;7jA{W'/Y14K,(1.Gc <br />EjrT 10 <br />-F-) BE 0CT(ZR/vUN0::) ISV gla <br />CONTR. LICENSE # <br />USE OF BUILDING EXI51I06 HEAT SOURCE CONTRACT ORICE OF WORK <br />6hvR 0H _ Electric _ Gas _ Other To <br />WORK DESCRIPTION REPl4I►Z CDJJS RL t� £C{�Ar151�/✓ OF EXISTIh/6� NARK"6- Go'I <br />IMp(ZWU'1(j�,'TS To s/I'(E. AUES5 AtOO IiJr0ZNAL TPAFFIC, [.IRe't/L'L-r Q. <br />E�!5-t11./6 n1A11./?ENANG�. gVIt.1�IIJ6 D�mouTlonl �' C,ot`JST�tlGllorJ of /� <br />IJ EW M PI N T F7vANLF f3t/It.1�IrJ6 <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ Toilet <br />_ Bathtub <br />_ Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink & disposal <br />_ Dishwasher <br />_ Clothes washer <br />_ Water heater <br />_Sink (service/barhncp/etc.) <br />_ Backflow preventer <br />_ Urinal <br />_ Drinking Fountain <br />_ Floor drain <br />_ Grease trap <br />_ Roof drains <br />Other _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ A/C — air handling units <br />_ Forced air systems <br />_ Gas piping <br />_ Water heater <br />_ Gas fireplace <br />_ Gas range <br />_ Clothes dryer <br />_ Range hood <br />_ Exhaust fan <br />_ Heat pump <br />_ Unit heater <br />_ Boiler <br />_ Refrigeration <br />_ Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />k <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing 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 state or local law regulating construction 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 the <br />State Contractors Law 18.27 RCW and 296.200 WAC. { <br />'lz <br />