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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.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 — 9--2 —D% <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />�� �' <br />r� a • �T s, I vo ��ze n s�D <br />I EGAI LOT NO. BLOCK TRACT OR SUBDIVISION # <br />DESC. <br />OWNER S�eA REVCITY: ZIP PHONE <br />Se"r�'ID JEnfT�►zEs N ,�.�;,re.Es /� zor,.zz.3.9soo <br />LVC�I-Fa LLG ---- 3Z o• /OG7W Ave— nJ� _ 5 <br />TENANT NAME NTACT FOR PERM T PHONE y,eG • 3z.5 • zs's3 <br />.lMe ear.. JD", 4LD <br />L-*- ! �E•MAI Q,6hr,4h17L� L <br />R —/�` <br />COS <br />CONT ACTr ADDRESS IT_ ZIPP <br />-z <br />,A coKpe2.e//,D,�/ 15E/ nl. 200-""s7- :5ht9 ,rJ& <br />CONTR. LICENSE # U ZOG •533 • Z191 <br />e 'emc 2 *A <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />D Av / <br />INC Gas _ _ Other <br />7i �� ! 30 �- <br />I / <br />WO K DESCRIPTIO <br />�26JLot5—r60AN?-r/n4rL?. u-tkv,6JT 15v/Lb ou'r <br />1� A-rrA-c-HeaD -ir, STKJc,T re ,,L r> 44s <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />_ _ <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Kitchen sink 8 disposal <br />Water heater <br />Gas fireplace /// <br />\ <br />Jr <br />_Gas <br />range \/y� <br />=Dishwasher <br />Clothes washer <br />_Clothes <br />�. <br />dryer \V <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backllow prevenler <br />Hoat pump <br />_ <br />Urinal <br />Unit healer <br />Drinking Fountain <br />Boiler i <br />_ <br />_ <br />Floor drain <br />Refrigeration <br />Grease tra <br />WOedsteve <br />_ <br />_ <br />Rool dr ' s <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 910'_ <br />1 hereby ceritify that I have read and examined this application and'. -.ow the same to be true and correct. All provisions 0f laws and <br />or Jinac governing this type qqq1 work will be lied with whether specified herein or not. The granting of a permit does not presume <br />I glue a thority to violate or cajTcal the provi o I I any other slate or local law regulating construction or the performance of <br />eonstruc on. That I am a Ihori d by the o of this property to perform the work for which application is made and I comply with the <br />State obtractors aw t8 7 R W £S .200 WAC. <br />•ZG •b <br />SigCthori�ganDate <br />Kr_ <br />