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C c � <br /> 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 /> /�j APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM _ <br /> SITE ADDRESS PARCEL TAX I.D./ PERMIT f <br /> �n��T � , ooy.i�.�_�,�ur,i 7o-c� I �7// 30 <br /> LEOA lOT NO. BL7CK TRACT OP.SUBDM81011 I <br /> oesc. _ LO '� � -Z� EVE��/%5 J�'•/�/ViSiON "O � � <br /> OWNER ADDR SS CITY2IP PH E <br /> /� / n �>.s�s-a��y <br /> /CA✓E/✓ L�IiNCTs �-Q�/SR✓�T�o� /S// �.SSGIi�SEA%/�fGvflc�/03 <br /> TENANTNAME _ I CONTACTFOi�PERM PHONE ¢ZS'Z5� -��Z'��+ <br /> �mp�e�szion ��5�c,ad '�rvi��rv5�cr�c)e:��Jn�' <br /> -tz�mr. r E�YINL h.stmi• l. c�, <br /> ,1v�M .N,n,� s G:vaSr72u�.r�c�11 .s�� �� . sS'�s�.�AIll65��3 ✓x)S5's-zay <br /> CONTR.LICENSE/ <br /> USE OFBUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> R - 3 I _ei�i� .,�eg�Como� <br /> WORK�fiBCRIP710N _� � (�S 1 C, ¢s_ <br /> �,} �.l IT ) �f soFs <br /> PLuM61NG MECHANICAL <br /> NO. TYPE OF FI%TURE OR IiEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathlub Forced air syslems <br /> � , Lavatory(wash basin) Gas plping <br /> Shower � Waterfreater <br /> / klchen sink 8 disposal Z Gas flreplace <br /> T Dishwasher Gas range <br /> � Clolhes washer � Clothes dryer <br /> � Water healer Renpe faod <br /> Sink(service/bar/mop/elc.) � Exhaust(an <br /> 8ackflow prevenlor Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> _ Floar drain ,� RefriperaUon <br /> Grease lrap Woodslove <br /> Rool draina Other <br /> Olher <br /> CfTY OF EVERETT LOCAL SALES TA%CODE IS]105 <br /> I hereby ce�itiry lhat I havo road and examined this epplkaUon and kraw lhe same to be We end correct. AII provisbna of laws and <br /> ardinaces goveming this lype ol work will be compliod wilh whelher speci(fed herein or rw4 The granUng ol a permit doet ral prosume <br /> to give aulharily tu violala or cancal lhe provislon ot eny olher slate or local law regulatlng conslructlon or the performance of <br /> consWclion.That I am aulhorized by lhe owner ol this property lo per(ortn the work lor which appllcatlon Is mede and I comply wflh the <br /> Slale Contraclors La 18.27 RCW end 296200 WAC. <br /> �J/a' .-� � �l'�`l_ �7 <br /> J�i Sig a ure ol wnor/Conlractor Agent Dale <br /> j /� <br /> l <br />