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� / <br /> PERMIT APPLICATION ,, � � � � <br /> CIl'Y OF EVERET7 PERMIT SERVICES f/ �7 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � �2- -1 `� / <br /> 425-257-8810—FAX 425-257-8t357 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM �J AM TO 4 PM P G } 7US — U l� <br /> SITE ADDRESS PARCEL TAX I.D.k Pf�,RMrI�T# � <br /> $l7D �d .O¢N l�a '�'D�II.?iDO/0 OD JS / O� - CI��— <br /> LEGAL LOT NO. BLOCK TRACT d�� <br /> DESC. .�- �� SB2 +`t`��s+l17� 1� L���"/ �lOh <br /> O�YNER ADDRESS CITYIZIP PHONE <br /> Gon�ntvir;'� fla,lth leNfer� <br /> TENANT NAME CONTACT FOR PERMIT .rQr���rQ9o� PHONE <br /> Sa�n� Chr�sha.� C�.�n��•.��tto,-�,a[d krtt,�fed� yzs•�7g•�s3 <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> �;� . �3bo�`Conyffv�ioh �r2 ��°°�t '��7 5. s�,�� �2od) y67-SSoo <br /> CONTR.LICENSE# �fjJj� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> IidH71Hf.'a'�'/��'f►B ��itP� I _ElecMc ?�Gas_Other f C���� �%C� <br /> WORK DESCRIPTION <br /> G'on5frt/�tf� a Aect/ z'S�'`'ir7 O�FFr� Bv,7c�l, <br /> PLUMBING ..Qy�h $vrlt� MECHANICAI - 11e5I y <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR REM ���"� <br /> �/ Toilet A1C—airhandlingunits <br /> Balhtub Forced air systems <br /> 1 � Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal _ Gas freplace <br /> I Dishwasher _ as range <br /> othes washer _ C hes dryer <br /> La dry lray _ Ran hood <br /> ( Sink( ice/bar/mop/etc.) _ Exhaus n <br /> Backllow venter Heat pump <br /> Urinal _ Unit heater <br /> Orinking Fountain\ _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Rool drains Other <br /> Olher <br /> CITV OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined lhis application and know lhe same to be true and corcect. All provisions of laws and <br /> ordinaces governing this lype o(work will bo complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision ot any other state or local law regulating conslruction or the performance o( <br /> construction. That I authorized by the owner of this property to pertorm lhe work for which application is made and I comp�y with the <br /> State Contractorrs w 1 CW and 296.200 WAC. <br /> �� --- s 3 0-� <br /> SignaWro of O dCoi r o.lAuthorized Agent Date � /� <br /> � <br /> �.L �ir.i� "3u.��t,�:a�;•;• <br />