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F�RMIT APpLICAT�uN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CED.4R STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />� APPLII <br />I���%� `�`� `�� �s,� <br />SITE ADDRESS � <br />-�"" <br />LEGAL LOTNO. BLOCK <br />oesc. � � .. _. _ . <br />ARE ACCEPTED FROM 8 AM TO 4 PM <br />I�OT�/� PARCELTAXI.D.# <br />I 17C4�O1C— C01' CO-1 ' <br />TRACT <br />I p r_ Seo�i � av�, l�l "I e..s�.�.' <br />JWNER GM�,�tJ4iJl�ci[1 nvunwa <br />ArAa\R-�YlV7.QG..��3t'$��-Lf (1(�3�'bl���UtSrC <br />TENANTNAME <br />eeti� <br />�_os-d7 <br />C�10�-1 I -��� <br />�w ��(�'d0( <br />PF�RMIT #_/J <br />,//%�/ U� <br />��a.. N E� W .GL . <br />+or+e _"1V3-li(1 <br />y aa <br />CONTACT FOR PERMIT PHONE <br />t, y�..1 L e SS ��y �I � a' • �'13 - l'1 l 8 <br />CONTRACTOR AODRESS CITY2IP PHONE <br />A�aiRE��:��-QGz�S�-S,L�C. l"103�'is'��.iue SE a�g�� �(�S -74�'1118 <br />CONTR. LICENSE M <br />USE OF BUILD/ING <br />S�(�q�L \ bM�1� KC9�a�G.A} <br />J <br />HEATSOURCE <br />_ Eleclric ✓Cas ___ Olhcr <br />WORK DESCRIPTION <br />��.:a.4.�.t_� , e,.- .,� .H.�..= �.s. !�-a�.: � ��,,, a � <br />PLUMBING <br />NO. I TYPE OF FIKTURE OR IIEM <br />f, Toilc� <br />'�. _ Balhluti <br />_y_ Lava�ory (wash basin) <br />Shower <br />I Kilr.hen sink 8 Aisposal <br />�__ Dishwasher <br />� Clo�hes v�ashcr <br />_,__ Walon c�alcr <br />SinM. (serviccl6admop�Mc.) <br />I Backllow prevontor <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grcase trap <br />Rool dralns <br />Other <br />CONTRACT PRICE OF WCRK <br />�� �p� bOd• ., <br />t3�,-o.a.e��tt aa b <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C - air handling units <br />I Forced air systems <br />� Gas piping <br />_ j_ Water heatcr <br />�_ Gas fireplace <br />_1 Gas range <br />�_ �lolhr.s dryer <br />�_ R�ngc hood / (�'�iReo <br />5 E-rhaus�fan <br />_ Hr.at pump <br />Unit healer <br />�ailer <br />_ Refrigeration <br />W oodslovo <br />--- Oth�r <br />CITY OF EVERETT LOCAL SALES TAX CODE 13 9105 <br />I hereby ceritily Ihal I have read and oxamine.i ihis applicalion �nd Annw lhe s�mo to be Irua and correct. All provislons of laws and <br />ordinaces governin� Ihis type ol work will br. r,omplieA with whether specilied hmein or noL 7he gianling ol a permit does mt prasume <br />to c�ive authority to violato or cancel Ihe provision ol any uther slate or lor.al law regulating construclion or tho perlonnance ol <br />construction. Thal I am auU�orized by tho ovmer ol lhis p�operty to perlorm the work for � hich applicalion is made and I comply with the <br />Slalo Contractors Law 1827 RCW and 2�J6.100 WAC. <br />t /� <br />