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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.everellwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />PERMIT N <br />sorm- <br />Z60SUtDIi9i93Bo c�G <br />,(� ��%�'.J <br />LEGA LOT' N0. <br />LOCK <br />BLOCK <br />TRACTOR SUBDIVISION N <br />DESC. <br />OWNER ADDRESS CITY,ZIP PHONE <br />y ZO (e <br />� <br />�ovr.lo <br />D•��� LUG 3Za-I zz3.9Sao <br />L c,- 12 r �� wl$ 1.1.1' 9Beo�}' <br />TENANTNAME CONTACT FOH PERMIT PHONE PHONE LOCH• 3Ly•20$1j ' <br />Jaxe Lom •..+.k o�)� <br />L.v Ar .4Adi,�M—t� pyJr-J6lt, E-MAIL�j L <br />CONTRACTOR eAA AGURES9 CITY/ZIP PHl3N-€- B <br />t5&1 �. z�*`�gT <br />CONTR. LICENSEN 2O4.•533'12.°II <br />f <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />6T:G W IF, �-t 5 <br />I 4 Electric X Gas _ Other <br />s� Ord <br />WORK DK D S <br />isr>;-�"a-aka rt'Rr� • o-Cbtlzv -� 4• I <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handlinq units <br />_ <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heat <br />_ <br />Kitchen sink 8 disposal <br />Gast ace <br />_ <br />Dishwasher <br />_ <br />range <br />_ <br />_ <br />Clothes washer <br />Water neater <br />Clothes dryer <br />Range hood <br />_ <br />Sink )service/bar/mop/etc.) \ / <br />Exhaust fan <br />Backllow proventer v ,/ <br />Urinal FP <br />Heat pump <br />Unit heater <br />�-^��'` <br />- <br />Drinking Fountain v, <br />Boiler <br />Floordram JC/ <br />Refrigeration <br />Grease trap 'Q <br />Woodstove <br />Roof drains <br />Other _ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordi aces governing this type of work will be complied with whether specified herein of not. The granting of a permit does not presume <br />to gi a authority to violate I cancel t provision of any other state or local law regulating construction or the performance of <br />cons uction. That I am aul iorized Vjhe owner of this property to perform the work for which applicalion is made and I comply with the <br />Slat tors L w 18. 7 RCW a d 296.200 WAC. <br />Sign lure of w ant ctjnAuthonzed Ag t Date <br />14-4 Iran� s-t:440/c— <br />1 <br />