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� <br />� <br />� <br />f- <br />PERMIT APPLICATION <br />CITY OF EVE#t�TT 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 S� <br />� � /O S� � ✓!y�' -t � <br />LEGAL LOTNO. 6LOCK <br />DESC. <br />Lw.a{i'ti,��� CV�1'S� ��C <br />TENANTNAME <br />V �.•..n.v� w� �'"'n <br />PARCEL TAX I.D. # <br />�1`f�.51 S'ct�l yu <br />TRACT <br />AUUHCJJ g <br />`-r'3'13 �V�n �i�� <br />C/O�NTACTFORPERMIT <br />��1 FrS�C. I7�-�1 <br />_ � �. a 4 /C� <br />PERMIT # <br />0�-d� <br />. cjyc�.y��...97a� <br />C�i `i� b�.o <br />PHONE <br />'�L5 � 4t71-� 4�'� "7 <br />CONTRACTOR ADDRE55 CITY2IP PHON3 } <br />�5 i�<-�.�'�r��,�al.�,>,;�-�1+��,� >>oErtYl-hkclri 111�nroc 9�u`d7� �: -`78y� <br />CONTR. LICENS q <br />GS �-E�'�G � 93q_ RK <br />USE OF BUILDING <br />HEATSOURCE <br />_Eleclric �„Gas <br />CONTRACT PRICE OF WORK <br />Other � �0���3, 7U <br />WORK DESCRIPTION 1 '1 I ` / � Q <br />r1-Y�S�� � fY'3f-(t2'7�n"1 �'N'i�a-�.w�l 'S�i+�.�Y 'w�l �l�Y�f�l��{�y� <br />��n-� �s r'� �'f,/��"7 :1� '� �G LCf1v �. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BaihWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry lray <br />Sink (service/bar/mop/etc.) <br />6ackflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greaselrep <br />RooF drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced alr systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 1105 <br />I hereby ceritiry that I have read and examined this application and knoW th2 SAmO t0 b2 ffl1A 9Ad COnACI. QII p�OVISIO�S df �2WS 211d <br />ordinaces governing thls type of work will be 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 of any other stale or local law regulating construction or the periorrrance 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 />State Contrattors Law 18.27 RCW and 296.200 WAC. <br />u—, <br />