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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 PARCEL TAX I.D.N PERMIT M <br /> 515-600 f.. sc 00 tial 000 Otg Oq W lino-w(.0 <br /> LEGAQ LOT NO. BLOCK TRACT OR SUBDIVISION <br /> DESC. W poo p-Oq I-1t6f4LAWD ACRES <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> AnA I Uvlc Grounds SIS-U6SYSF_ FVerGtt 9FZ03 y2S-- 353-'A" <br /> TENANT NAME CONTACT FOR PERMIT PHONE 4/LS-253 -7464 <br /> OWNEILS I CHRIS GRo KN DS EWAIL04YLVIt/so/kiTf`,2oh <br /> TOR ADDRESS <br /> rV— Raw <br /> COCLI / 1 /CENSE 0 A Z <br /> USE OF BUILDING VVV HEAT SOURCE CONTRACT PRICE OF WORK <br /> PA-T-10 (AJGR- _Electric _Gas_Other 111500 <br /> i <br /> WORKDESCRIPTION Appcfr. Z00 sE 11 <br /> Re�IiAr� sky Roof by gem del t0 '{-f¢. 'Info eA154;#1 roof of I'-juse. <br /> aAd e,cfend.'A9 .1v proviolL Cover -oro loc.e-k e+epl venal 96Q eA+:o. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM A //] NO. TYPE OF FIXTURE OR ITEM NQ <br /> _ Toilet �//-{ _ A/C-air handling units / r <br /> _ Bathtub _ Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> _ Shower Water heater <br /> _ Kitchen sink 8 disposal _ Gas fireplace <br /> _ Dishwasher _ Gas range <br /> _ Clothes washer _ Clothes dryer <br /> _ Water heater _ Range hood <br /> _ Sink (servicelbar/mop/etc) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodslove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1103 <br /> 1 hereby certify that I have read and examined this application and know the same to be true and coned. All provisions of laws and <br /> ordinances 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 wolate or cancel the provision of any other slate or local law regulating construction or the performance of <br /> construction That I am authorized by the owner of this pyoperty to perform the work for which application 1s made and I comply with the <br /> State Contract Law 18.27 RL�SC rid 2 00 WA / <br /> gnature wne/ onlractorlAuthonze Agent Lrdle <br />