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09/09/2009 W6D 15: 43 PAX 3606686140 Canon �002/005 <br /> \ <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810— FAX 425-257-6857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 9`C�.�� <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT <br /> 1�'a .� c�� L'"C ��� >> c� � �� o - 3 <br /> LEGAL LOT NO. BLOCK TRAC'f OR SUBDIVISION M <br /> DESC. <br /> OWNER A�DRESS CITV2IP PHONE <br /> ���0 ��C�� �\�. �.���L�<�\ C�:�' ��)ut�.� �t�����.s-3�t ( <br /> TENANTNAME CONTACTFORPERMI7 PHONE <br /> _�� �� (� /1 �{z�. Z ��z . S3�i l <br /> ���.� \�,�}�1d'�1� E•MAIL <br /> C��p���/��� ` ` /� b RESS .�n �;�IT�1r,,/,�� c�_ <br /> y-j-v v `cc.� iC�., t��U� Y'�.�r't�. `��r��a� cJs-- �t SL rJY Vl�[-vhlp'\ 1 <br /> CdNTR.LICENSE# L`Z'�• ��'�'5.,�31a <br /> A'1�'�'-((J?�I'(���Y�( <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> 6lectric �as Olher <br /> WORK DESCRIPTION <br /> ����.�.�:r` �.C.e.J ��P.(:� (�J�)(v�,� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathlub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Wa�er heater <br /> Ki�chen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes w2sher Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Ezhaust 1an <br /> Backllow preven�er �_ lieat pump <br /> _ Urinal Unil hcater <br /> Drinking Fountain Boiler <br /> Floor drain Retrigera�ion <br /> Grease trap Woodstove <br /> Roo(drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> �here5y ceritily Ihat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governinp this type ol work�vill be compliad with whether specilied herein or not.The granting ol a permit does not presume <br /> �o give authorily to violate or cancel the provision of any olher stale or local law regulating consiruc�ion or the performance of <br /> consiruclion.Thal I am aulhorized by the owner ol(his properly to perform the work lor which application is made and I comply wi�h ihe <br /> Sta i ractors a 1627 RCW and 296200 WAG. <br /> � � ��>��, �7 �I.. c�� <br /> Si na ure u O� edContractor/ u honzed Agent Date <br />