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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.orcl � �� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRF�SS <br />�i�7 /ro�Kt°�e'llt°��'/� � � � <br />LOTNO. BLOCK <br />i,(t(� IC/ii� K <br />TENANFNAME <br />������� � <br />V Lvks ���r�� �l) �-S/ c.r f��� <br />CONTA. LICENSE N j !�� T�g� O� <br />W nJ ��— <br />USE OF BUILDING � <br />) � ' _ �; <br />I�f s<<���,�f �� <br />WORK DESCRIPTION <br />PARCEL TA% I.D. # <br />�d =j �S '0 GG <br />7AACT OR SUBDIVISION # <br />ADDRESS <br />., <br />��r��j�ll�',-�I �,.� <br />CONiACT FOR PERMIT <br />�����a[�i�� <br />M�+� <br />i � 2005 �� <br />CITY OF ............... <br />ne�.;.,_ ._EVEpc,::•.�.,. <br />I '� �i o 3-1 `� <br />;IlY21P PHONE <br />; ��ir`// `�'��-1 ,���-`7� (S/0 <br />PHONt �� r7�'�Sj� <br />/�SJ� ��c%ar,t� t%1['�.�%..��_.. <br />/�/l.e✓u� � f,�J4 %dU S <br />� y�e <<� <br />jjOU - <br />97g-�s�s� <br />. HEAT SOURCE I CONTRACT PRICE OF WORK <br />�� <br />�Electric Grs Other �' ���il <br />� � � ��, �.i . �i�%�_/"C.e'" <br />�_ l�)�r����� Cl « � �U <br />NO. I TYPE OF FlXTURE OR ITEM <br />Toilel <br />6ath�ub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposat <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (service/bar/mop/etc.) <br />Backllow preven�er <br />Urinal <br />Drinking �ounlain <br />Floor drain <br />Grease�rap <br />Rool drains <br />Other <br />ND. I TYPE OF FlXTURE OR I7EM <br />A/C — air handling uniLs <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas (implace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustlan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CI7Y OF EVEREIT IOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify ihal I have read and examined this application and know the same ro be irue and cortect. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specilied herein or not. The granting of a permit does not presume <br />to give aNhority to violale or .3nr.r.l the provisinn of any olher sfata or loral law reputating cpnstruction or the pedormaoca of <br />construclion. That I am authorized by the owner of this property fo pedortn the work lor which application is made and I compiy Kilh lhe <br />Slale Co{1lractors Law )8.27 RCW and 296.20D WAC. <br />' ,�' I �i l� � 1. .�...: <br />i <br />' _ � l. � � � �. � \. � l, �i I _ j ( �� _ -- � �� � �� _ <br />