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NOV 04 2010 12; 47PM HP LRSERJET 3200 p. l <br /> �� 6� \ �r: Pe�;_t o � a-- Gt� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3240 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-887 D— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TA7(I.D.A' PERMIT I! � <br /> 1 r r� J� - l <br /> LEGA LOTNO. BLOCK TRACTORSUBDIVISIONR <br /> DESC. <br /> OWNER ADDRE38 CITYILP PHO <br /> 2'�-4�r - N� 1� (��clr�rv� � �Dic�.v� e ��tyS� � .� � \IOS��y <br /> TENANTNAME CONTACTFORPEFiMR PHONE: ��b 'a101 • �'.7/� o <br /> W W �Trn e G�AY�1 C. �L�AD�EB�-v�\���`1TPIZIP—� �`x� \ � ✓l 4 <br /> uJvvr�C i 1A � <br /> ZfP C�„ <br /> �7�n <br /> CONTR.LICENSEY ����k\M� ��� mS �✓7 , �Jj�; Q <br /> l L / <br /> U3E OF BUILDING I HEAT SOURCE l, CO�iTRACT PRICE OF WORK <br /> 40. j- <br /> ���,� ���` �Electric Gns Olher I l Q G�� <br /> �� <br /> WORK OESCRIPTION <br /> �����. ����� 1-�-� N��vz�N ���e�rz.� <br /> �����_ zo�w, 1��, oao �-r.� 11�.�- �le��.c. .�a�� <br /> PLUMBING MECFIANICAL <br /> NO. TYPE OF Fl7(7VRE OR ITEM NO. TYPE OF FI:fTURE OR ITEM <br /> Toilet A/C—olr handling unlls <br /> 6alhtub Forced air systems <br /> Lavalory(wash UaSinJ Gas piping <br /> Shower � Wuler hoator <br /> Kitchen slnk&disposal Gas fireplace <br /> Dishwasher Gasranga <br /> Clothes wnsher Clothos Oryer <br /> VValer heale� Range hood <br /> Slnk(sorvloolbar/mop/alc.) E�ausl fan <br /> _ �ackflmvpreventer _ Haatpump <br /> _ Urinal Unitheater \ � . 5����lN <br /> _ Dnnking Founlain _� Boiler -� �`cl�"GR- (� `—�,p� <br /> _ Floor drain Rofrigeretion 2�•, <br /> Grease trop Woodstnva ��' � ��� g� <br /> Roof drains SIher <br /> _ Olher _� 4���iJ.^Sf_�.� �oO�L w p <br /> CITY OF EVERETT LOCAL SALES 7AX CODE l5 3105 <br /> I hereby cortiiy that I have roatl and axumined this eppiicatlon end know lho same lo ba lrue and carracl. ,�II provisions of laws and <br /> ordlnances goveming Ihis typo of work�WII be compG�d with whether spxifietl horoln or not.The granling of a pormil does not presume <br /> to give auU dty lo�iolato or wncel tho pruvision of any other state or lowl law regulating constructlon w the perfortnence ol <br /> constru�tio� .That I am nuthorlxod by tho o�vnar of lhis property to pedorm the�wrA for which application is made nnd 1 comply with Ihe <br /> Stalo Co ors Lew 18.27 and 296.20U WAC. • n�/� <br /> — �� (/ <br /> CS at 4 vn ntra ulhorizetl .a Date <br /> � �� �� �� � <br /> �-t- - °� �(�2 � 2 � � C4l <br /> � �� �� � � � 3y <br />