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00/2J/Y007 15:4i I�:IS (m00L'/005 <br /> ' 6 - �f� -n > <br /> PERMIT APPLICATlON <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 <br /> StTE ADDRESS PdRCEL TAX I.D.# �ERM17 R <br /> .� 9 cv/b Hve /f� ) `r., � <br /> LEGA LOTNO. BLOCK TRACTORSUBDINSION• <br /> DESC. <br /> OWNEH `� .I .(,�LI.�YJC-QL' �-C C(C1��J.:1 ' CITY2IP PHONE <br /> T�:I�r� P�ucln� a 3 Co( b Au Cv�r�tf• y8aol aS3-�Yy-yolo <br /> TENANT NIWE I COHTACT FOfl PER IT PHONE <br /> as3 -S�a -yyyy <br /> Gsc�,elvr TelccuM E�e+ct� G.Pi � ps C � e�wa� <br /> OHiA CTOR , ADDF_SS CfTYlLP PNONE <br /> Q;, srs+��s �.,y,�«„�, zh�. 3coa s. p;..� st 7G4•MF�WA gsrvo7 <br /> CONiR.LICENSER �� R SYE�aaS KN /7���y� <br /> E— �,ss-s��- yy8y <br /> USE OF BUILDINO HEAT�SOUFiCE.. � CONTRACT PRICE OF WORK <br /> _Eloctric ✓Gas_Otner � = ,� 6� O N6 <br /> WORKDESCRIPTION K�r�Gcf / fc.s�C/et�i'ie �'oO�f/v� Gn�f wl�fl. JA... t «ru�,fy <br /> Ncu un�f �} l/j�frr <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM ND. TYPE OF Fl7RURE OH REM <br /> Toilei A/C–nir handling units <br /> Balhlub ForcoJ atr sysloms <br /> Lavatory(wash basin) Gas pipinp <br /> Showor Walor hoater <br /> Kitchen slnk&disposal 3as lireplace <br /> Dlshwashor Gas rangu <br /> Clothos washor Clothes dryor <br /> _ Wator hoator Range hood <br /> Sink(servicu/badmop/otc.) Ezhaust lan <br /> Backilow prevallor Heat pump <br /> Urinal Unif heater <br /> Drinking Fountatn Boiler <br /> Floor drain Peldgerelion <br /> _ Groese trap Woodstove <br /> Rootdralns _L/ OlherGc.s/G/eefrlt <br /> _ OlhOf _ renf/�.. uh�'l <br /> CIN OF EVERETT LOCILL SALES TA7(CODE IS 7105 <br /> I heroby coritify thal I have read and oxaminod this appiicatlon and know the sema to be true and cortact. All provisions of laws end <br /> � ordinacos govorning thls type of work will bo complled with whulhor spocifiud haroln or not.Tho grenting ol a pormit does not prasumo <br /> to givo aulhority to violate or cancol the provision ol any other stato or local law roguladng wnstruction or the pertormenco of <br /> construction.That I am authodzed by tha mmor ol thls property to portorm the work for which application is mado and I compty with the <br /> Stato Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> /� e�s� 7a/�aytJN 6-�/�U7 <br /> Signeturo ol Owner/ContractorlAuthorized Agunt Oate <br />