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3G� 3Ly . PIRMIT A,PPLICATA <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, LVERETT, WA 98201 <br /> 425-257-8810- FAX 425.257.8857 - www everettwa org <br /> to APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P10 q�n • d i� <br /> SITE ADDRESS P CEI-TAX I.D.H PERMIT 0 <br /> _ SIS 12G�—QG - CSI_ C 90- 002 <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER - - ADDRESS CITYQP PHONE <br /> TENANT NAMEI CONTACT FOR PERMIT PHONE <br /> �---- _--�7C661iE r i E-MAIL <br /> — <br /> ZGLC.r , �UMtS , �1Ani� A -14G 1� S1tuC s yZT Lis - v��� <br /> CONTR.LICENSE p (oL( lit 4 i4a <br /> -&ALASLN.1` 4fdb G wn• <br /> USE OF BUILDING ( — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 2 ( Sit F , Elxtric ZGas Other <br /> i <br /> WORK DESCRIPTION <br /> �. 1 J A SAW. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Tohet _L A/C–air handling units <br /> Bathtub I Forced air systems <br /> Lavatory(wash basin) * Gas piping <br /> Shower 1 Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> / Dishwasher I Gas range <br /> Clothes washer 1 Clothes dryer <br /> Water heater Range hood <br /> = Sink(service/bar/moplolc.) S Exhaust Ian <br /> _ Backflow preventer Heal 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 3105 <br /> 1 hereby centify 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 omptied with whether specified herein or not.The granting of a permit does not presume <br /> to give uthonlylo v+elate or cancel the pr ision of any other slate or local law regulating construction or the performance of <br /> con uction.That arraulhonz er of this property to perform the work for which application is made and I comply with the <br /> SI a Contractors a CW an 96.200 A <br /> Iv 1 meq <br /> Signature of 0 ner/Ce Ir t rlAu o Agent C d. <br /> 1 <br />