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02/02/2010 TUC 9: 3G �AX 360668G140 Canon �002/003 <br /> �. _'_ �� '_— — <br /> PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 -�waw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS pARCEL TAX I.D.# PERMIT# <br /> yGZ�� Ft���Ay �J� Oosq4,2 G03cU>u0 /1:�_ �' <br /> LEGA LOT NO. �LOCK TRACT OR SUBDIVISION p <br /> oesc. 5'/z��+3 :f,l,ct-y C�o3 '�-tx "�"Grc���G A�b �-� C:vc�re.`1-�• <br /> OWNER AOORESS CITY2IP PHONE L�ti Z�5 ? <br /> a)J- <br /> �.v��, �'S�� c.�l �ti1ZS" Sm.�cy�1 G�s Cc�vc'-. �.r) ,11vk, l�.0�2�?� I ���5� <br /> T[NANTNAME I CONTACTFORPERMIT PHO1�NE (- <br /> ��J� �G]�fJ� o f"��� <br /> m0.t�' Swc`l-m�,�� E•MAi� ��L.i�.�, (l�Y1C�-�:��6L�41�" <br /> N R ODRESS T P 0 E ` ��� <br /> f�m�,c�� c�c. .s �esy- l-S-eN,� r rt� 11�1 I Z Si �3 S�: 6(lo>-Son1�c�1 Q�ZqW L��j� <br /> CONTR.UCENSE N ��� ���Q <br /> � n�� rcic� y � 2�� �«:, <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��'���a L'-�>> + �'I Eleclric �' Gas Olher �' �'1�J UC� <br /> WORK DESCRIPTION r <br /> t=���,u.c_� ������-c�l1c.�-�c�� �Dsz.cvlcr��l , Wr� �Xa��Sio-�� c�'t�'C��,.� � in� <br /> PLUMBING MECHANICAL <br /> N0. NPE OF FIXTURE OR ITEI�I N0. TYPE OF FIXTURE OR ITEG <br /> _ Toilel A/C-air handlinp unils <br /> _ 8athlub � Forced air syslems <br /> lavalory pvnsh basin) I Gas piping <br /> ^ Shower Waler healer <br /> Kilchen sink&disposai Gas fireptace <br /> _ Dishwasher Gasrange <br /> _ Clothes washer Clolhes dryer <br /> Wnler healer Ranpe hood <br /> Sink(service/bar/mop/elc.) Exhausl fan <br /> Backllow preventcr Hea!pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeration <br /> Groase�rap Woodstovn <br /> Rool drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 liereby certify Ihal I have read and examined lhis application and know Ihe same to be Irue and correcl. All provisions of lav+s and <br /> ordinances governing this lypo of work��ill be complie�th�vhether specified hereln or not.The gran�ing of a permi!does not presume <br /> lo give authonly lo violate or can�el Ih provisi f-any other stale or local law regulaling construclion or the performance of <br /> conslruction. Th�{I�n�a ihori d b Hner of Ihis property!o perform Ihe work for which applicalion is made and 1 comply wilh lhe <br /> Sta IracJdrs L,nw 1 .27 a 2�J6.200 WAC. <br /> / � - <br /> l -z�- lJ <br /> Signatu e �e � n ct /Aulhorize ent Dala <br /> i" <br />