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PERMIT APPLICATION <br /> CITY OF EVERE77 PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425.257-8810-FAX 425.257-8857 -www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.If I P_ERMIT N. <br /> l0 SAI10105 ©0.2c�100 p 5- 00-7 <br /> LEGAL LOT NO. BLOC/K I TRACT OR SUBDIVISION k <br /> DESC. — GInC-'Gl — <br /> OWNER ADDRESS C{TY21P PHONE <br /> SSG C �..do �,�U... fl L LG Co 3 qz-z 4je Nt &LIC✓a, I,IA 2�r�`l�rsti f37f/-c,3a5- <br /> TENANT NAME a CONTACT FOR PERMIT PHONE <br /> bolla,r _qj,�: 731 (owl C�ffisFopf�r L)er`s (•l1-)77G- ff0-3S <br /> CONTRACTOy� ADDRESS CITWZIP PHONE <br /> i ii r y /�a� 700 f 1�.Mese r, k on� Cr r:Cf) wQ <br /> & qV CP 77C-AA C(�5)7�b -1TfS3S' <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORT( <br /> mo <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet ___ AIC-air handling units <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 healer Range hood <br /> Sink(service/bar/mop/etc.) _-_ Exhaust tan <br /> Backllow proventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain __ Boller <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Root drains I Other___ <br /> Other,_----- - -- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 8105 <br /> 1 hereby cerilify that I have read and examined this application and know b•-same to be true and correct. All provisions ul laws and <br /> ordinates governing this typo of work will be complied with whether specified harein or not.The granting of a permit does not presvine <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 /> Slate Contractors Lew 18.27 RCW and 28 .200 WAC. <br /> tom/ � l ✓ua-1 ?20,97 <br /> Si azure 010 wr ri ontractor/ ut ronzo gent Uate 1 1 <br /> /r� <br />