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( ) ( <br /> Q <br /> 1 <br /> 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.# PERMIT# <br /> .3 <br /> &I Evcref I-. Ave_ o05 93Gi G/38 coGo boo 7Oq 2 <br /> LEGA LOT NO. BLOCK[[� TRACT OR SUBDIVISION# <br /> DESC. /� 4. G38 SWALL.�lt.S _2' Adct,'ltem 1.U. 3 PIAT PAS ( I <br /> OWNER tib ADDRESS CITY/ZIP PHONE <br /> C)AciU Conir.sc+ rS P- 3C)( , 0,--I3 Lue,er-f• j9g,/ 3 Y25•07o•-71Y7 <br /> TENANT NAME �lk ------__1, CONTACT FOR PERMIT PHONE 1125 47C- 7Z -7 <br /> ��wS�e.I1a�ptuPec+.esiCJ <br /> N�� i-4- �,ec:IG EMAIL UQ�;10ale� <br /> CONTRACTO .-AUORESS CITY/ZIP PHONE <br /> Sou..ciu;e. -i-r--16-/c <br /> r -lir �.v (3ux aU�(3 C utc+� 5`;24:13\11- <br /> E32(3 /ZS •F;7o 7:Z c( 7 <br /> CONTR.LICENSE# <br /> O(11\CI C L `i 51 k GP ) l`l - Guj <br /> USE OF BUILDING HEAT SOURCE CO TRACT PRICE OF WORK <br /> /\A--X ed o Ste _Electric _Gas— Other (j'5 q d C'c <br /> WORK DESCRIPTION <br /> r l� ikParin„e..r-3. <br /> Com,,S�-i'VGr Ui-Tr'C � r v�r,,`J c '4' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet . • A/C--air handling units <br /> £t Bathtub - Forced ai; systems <br /> Lavatory(wash basin) •: Gas piping <br /> Shower A Water heater <br /> Kitchen sink Si disposal _ Gas fireplace <br /> '2 Dishwasher Gas range <br /> Clothes washer d Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) (, k xhaust fan <br /> Backflow preventer _r eat pump <br /> iUrinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration ilGrease trap Woodstove <br /> — Roof drains Other <br /> p Other <br /> ! CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I 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 c.siplied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cel the • . isi.n of any other state or local law regulating construction or the performance of <br /> construction.That I aniu(ioriz1-b At owner of this property to perform the work for which application is made and I comply with the <br /> State Contractor• 1�2 - . • 2_9>0o-W C, <br /> �, <br /> Signatdce'of_,./...--- ----;<•.,, <br /> vn r�/Coonlfacl�or/Authoi•-ed Agent Date <br /> 1 / IA- <br />\.k.,( <br />