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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 />SITE ADDRESS G <br />oG lAve SC <br />PARCEL TAX I.D. # <br />i l % X05� or 000 G <br />P IT # <br />7 �'S''33 <br />LEGAL LOT O. <br />BLOCK <br />TRACT <br />DESC. <br />250(0 316 • p C7 <br />OWNER G ,j7 OR CITYZP PHONE mp <br />6 , /f <br />m r.n �Gc .on S rn r <br />TENANT NAME <br />CONTACT FOR PERMIT PH NE <br />,1 <br />/\ Cn�I2.Sy�1 FT -Fr S ',4 Nchje1 %G'31o22q <br />CONTRACTOR ^ ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />/e _ - <br />J GG (Dn j <br />le L L uln :�' I <br />Electric JGas_Other <br />WORK DESCRIPTION •(- Moyle( L ro II <br />Sr1r.n N2XTa' � /'o,ScS '(•� Col �o Go'}L' pn or ltx;i'�. nr /l't on„r.lr <br />.f (37 Seetor5 � f 1, (�7 o„•I.., Ar4 1,<r <br />gre.,f r o'-:rM4 fe Alan �' <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />yLi <br />Toilet <br />uA <br />A/C — air handling units <br />AiA <br />Bathtub <br />'JT <br />Forced air systems <br />r p <br />Lavatory (wash basin) <br />7A <br />Gas piping <br />1 A <br />Shower <br />A)� <br />Water heater <br />ArA <br />Kitchen sink 8 disposal <br />m l <br />Gas fireplace <br />NA <br />Dishwasher U� <br />vA <br />Gas range <br />p <br />uA <br />Clothes washer <br />Laundry tray iL0 <br />A <br />Aj <br />Clothes dryer <br />Range hood <br />oh <br />Sink(servicelbar/mop/etc.) II ,,i(/ <br />yb <br />Exhaust fan \ <br />hiA <br />Backflow preventer V <br />AjA <br />Heat pump (� <br />.,b <br />Urinal <br />_mL <br />Unit heater <br />Drinking Fountain <br />A4 <br />Boiler <br />P <br />LA <br />Floor drain <br />Grease trap <br />"A <br />_UL <br />Refrigeration <br />Woodstove <br />Nt <br />Roof drains <br />Other <br />=Other <br />/ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 w ied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the prgv' of any other state or gcal law regulating construction or the performance of <br />construction. Tttat-I m authorized by th caner of this propert o-perform the work for which soplication is made and I comply with the <br />State Co tredors Lavi18.27 RC I and 296.200 WAC. <br />gnature of OwnerlContraclor/Authorized,A ent Date I/ <br />