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PERMIT A►PPLlCATION <br /> CITY OF EVERETT PERMIT SERVlCES <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 /> l�'� �7 `07 <br /> SITE ADDRESS L�C-K'L T7 PARCEL TNC I.D.p PERMIT A <br /> SI�a> C ✓. 5..,�< <br /> �.nqr�y G7f(� c � `� <br /> LEGAL LOT NO. BLOCK TRACT OR SUODIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �al� ��e S� �,c. - /�'�i ("i �N � �-1�. G ��'�Nc.,,i wA ��b2z3 ' 4Zs-zJi-�sr� <br /> TENANT NAME CONTACT FOR ERMIT PHONE <br /> �/LS- 2jl- Isr/ <br /> �L7o SToI' �1�i�1� �iUlG.v EdAAIL SiN(yN6J6(41A�L��a1� <br /> ��Z <br /> � 4� � �(( �n5�i.y MR�lZYsv��tE, �-'•� `(Jt7e <br /> CONTR.UCENSE# <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Eloctric _Gas Other ,� � S'on. �..,, <br /> WORK DESCRIPTION <br /> l T� .�1� -�. .t i G u ��P 4,�kb� , � _ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I Toilet A/C-air handling units <br /> �alhtub Forced air systams <br /> i Lavatory(wash basin) _ Gas piping <br /> Shower Water haaler <br /> Kitchen s:nk A disposal _ Gas lireplace <br /> �ishwasher Gas rango <br /> Clothes washor Clothos dryer <br /> j� Wator heater ��Nk u-Ss�.. ��,.Il..,f.� _ Ranpe hood <br /> Sink (service/bar/mop/etc.) _ Exhaust fan <br /> Backllow prevonter _ Heat pump <br /> Urinal Unil heater <br /> Drinkin9 Fountain _ Boiler <br /> Floor drain Re(rigeration <br /> Greaso trap _ Woodstove <br /> Roof drains _ Olhor _ <br /> Other ___ — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7/05 <br /> I hereby caritily Ihat I have read and examinod Ihis applicalion and 4�iow the same to be true and correct. All provisions ef laws and <br /> ordinaces povorning Ihis typa ol work will be complied wilh wholher;pocifieA herei�or not.The granling o(a permit does not presume <br /> lo givo aulhority lo violate or cancnl the provision of any olhor state or Iocal law reyulaling wn5trucUon or Ihe pedormance ol <br /> conslruclion. That I am authorized by the owner of this prop�rty to perform the work for which appticalion is made and I wmply wilh lhe <br /> Slaln C traclors L•aw 18.27 RCW and 796200 WAC. <br /> 6�4 !c. 1" ��,/9�o �. <br /> Si9nalure ol 0 edConlraclor/Authonzed AgoM Dale <br />