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�- � I-o '7 <br /> �- - -� -- <br /> PERMIT APPLi�CATiON <br /> CITV OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, VVA 98201 <br /> � 425-257-8810—FAX 425-257-8857—www.ev�rettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDR SS PARCEL TAX I.D.# P RMR# <br /> Z��)2 �6�' AV� (�U �� 1 �� � 802 5iav - ir' -, . <br /> LEGAL LOTNO. BLOCK TRACT n // <br /> DESQ !/t-��� (��G[ <br /> OWNER AUDRESS CITY/LP PHONE y�s-_3yy� � <br /> �Ul�� I�1Z���CILfICS �"/L�C l" 'C� .�QX ��S �L�/�'ZY, �G��} ���'7 <br /> TENANT NAME C NTACT FOR PERMIT PHONE <br /> 1� //�- � /�i�n�z�y /G���l'i�6z 2-- 2�.�� y���s — <br /> CONiRACTOR /�/_/OCI CL�U � � D�/x� ��'Z� � 3 A�TYILP PHONE��'J�j(�(„ <br /> � 1✓-J Y7��' �J 3'� ��L y�/�/� <br /> CONTR.IICENSEp Q �G/�/'�� I / ijO /' G'V� C���� <br /> / l ✓l.Jl. �p L lo <br /> USE OF BUILDINO ) HEAT SOURCE CONTRACT PRICE OF WORK <br /> yU1J1n'��2.0 v �(��' _Electnc _Gas_Other �OI CJ� d �� <br /> F-� <br /> WORK DESCRIPTION <br /> 12�rnoVl�-L D� �.�! 3'�i•J Rc���t� a ��C( r �� s-�-d /l�tr��u <br /> �'�� /✓L°I✓ /!'IvDirc� P�fi�ir,a.n /�oC}f' S yS7�i» , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF PIXTURE OR ITEM <br /> Toilet A1C—air handling units <br /> Ba[htub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhas washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> 6ackflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain 8oiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITYOf EVEREiTLOCAL SALES TAX CO�E IS�105 <br /> I hereby ceritify that I have read and examined this epplication and knowthe same to be true and correcL All provisions of laws and <br /> ordinaces governing this rype of work will be complied with whether specified herein or not, The granting of a permit does not presume <br /> to give aulhority to violate or cancel lhe provision of eny other state or local law regulating construction or the performance of <br /> construction. That I am aulhonzed by the ovmer of this property to perfortn the work tor which application is made and I comply wdh the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> Siyn„lure of O�:neUr,ontractorlduthonzed Agent Date I <br />