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Id1. 9. 2013 7:39AVI No.8941 P. 2 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-257.881 G - FAX 425.257-8857 - www.everattwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 ..q-13 <br />SITE ADDRESS PARCEL TAX I.D.p PERMIT N <br />9 Kshlre' or 5� _ 1ot3 <br />LEGA LOT NO. — BLOCK TRACTOR SUBDIVISION i <br />UESC. <br />OWNER ADbmkss CII RIP PHONE- <br />--- J son_ 7?A 115�'eSE LK S�evu�s _ Nz z 32 8 9_84 <br />TENANTNAME I CONTACT FOR PERMIT PHONE47-T.CONTH TO Z�•• �� <br />V1le GMAJIJP, ie@CmflddlR'1• C7111 <br />Cm IC 3c lnc- 1415 Cyr w� L-Vtretf gg7oi t}2`�25�1��o61a <br />MUM <br />CONTgC �t A0g5R4 <br />USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br />_Electric Gas _Other IIS33 <br />WORK DESCRIPTION <br />1nS-iu 11 Y�Qgf �u►�.� <br />PLUMBI 0 MECHANICAL <br />NO. TVPL OF FIXTURE OR REM NO. TYPE OF FIXTURE. On ITEM <br />Toilet A/C - air handling units <br />Dathlub Forced air systems <br />Lavatory (wash basin) _ Gas piping <br />Shower __ Water heater <br />Kitchen sink d disposal Gas fireplace <br />Dishwasher ._ Gasrango <br />Clothes washor Clothes dryer <br />Water hualor Range hood <br />Sink (servlce/bor/mop/Mc.) �_ Exhaust fan <br />Backnow provonter 1 Heat pump <br />_ Urinal Unit healer <br />Drinking Fountain _ Boiler <br />Floor drain _ Rehigetation <br />_ Grease trap _ Woodstove, <br />_ Hoof drains Other <br />Other --- - <br />v CITY OF EVERETT LOCAL 9ALLD TAX CODE 15 3105 !- <br />I hrreby cenllfy that I have read and examined this application and know the same to be Due and correct All provisions of laws and <br />Ordnaces governing this type of work will be complied with wholher spocilied heroin or not. The granting of a permit does nor presume <br />to give au!hority to violate or cancel Rio provision of any other stale or local law regulaling conrlrucuon or the performance of <br />consttueiton. Thal I am authorized by the owner of this properly to perform the work for which application 1s mado and I comply wl!h the <br />State Contractors Law 18.27 RCW end 290 200 WAC. <br />Signalu of Ownm/Co actor' ul gent Date <br />