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I <br /> �'�� �`S�f jn,uu ����y PE�MIT APPLICATION <br /> ( I�S � �" C�7Y OF EVERETT PERMIT SERVICES <br /> <:�0� CFDAP. STREET, EVERETT, WA 98201 <br /> h.'� :''�%-n8�0-FAX 425-257-8857-www.everettwa.org <br /> kF'PLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 -a/�� �b <br /> SITEADDRESS 4c� 14-i-H STt�tir a� ic� pqRCELTAXI.D.# pERM)�7g <br /> rti�n-c ��� wt. 9�2ni 2 icc� � tioo2o55co i ,; -C�� <br /> 7 <br /> LEGAL LOl'NO. BLOCK TRACT �r T.�� 3.r+J,N G- s�Tc P�..a�.. F�fL <br /> �ESC. Lpr2 POfTO= GVCYLcTT NO3.-T�-� Me�t�.-It�. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> rH� PoRT o�= evc2ETr P.U. iia:,�[ 53�� t•� rl1c�T w�a 9'dLOF, 1.8c�a . q-27' .�C+�� <br /> TENANTNAME � I CONTACTFORPERMIT PHONE <br /> r., u�sh fd'�� <br /> IHc Pc:�r oc B.. �ticTT RML v2cr1�TE�TS <br /> hTTN = vNTriUN`/ Cc�.vA 3�v . ���c; . �3-3 �3 <br /> I CONTRACTOR T 13 A ADDRESS CITY2IP PHONC- <br /> CONTR.LICENSE# <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �a - ��.�5 , a - rsa.�.a� 40 9 ��o.`= <br /> S 1� tc�J 1 PM C J T Eleclric � Gas Other � <br /> s_ - . ra.:o.•t� (eST. Fau�n co� FEr ;-nc,-.r�l <br /> WORKDESCRIPTION a N� 9�, C�ov 56p 2 S cuu, wa�D- FMni g Zn.u�=,��� <br /> FcJ2 OdAT�n��-J 5v ;'fr�(LT �-nC1� ITIC{ @ T�-1� pon.T o� tvcrr-� .-��S <br /> pJ2T GT�'7 NC12 C.(t0. j-TS !v�oJ DIS�f��T <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel � A/C-alr handling units <br /> Ba�h�ub Forced air syslems <br /> ,� Lavatory(wash basin) ��.� 3as piping <br /> �- Shower _� Waterheater � <br /> � Kitchen sink&�dis�t»el � Gas firep�ace 3 <br /> _ �Dishwasher '• Gasrange � <br /> _ Clothes washer _ �lothes dryer <br /> Laundry tray Ra e hood <br /> I Sink(service/bar/mop/etc.) � Exha�t fan <br /> _ Backflow prevenler Heal pu�hp <br /> Urinal '�, Unit healer\ <br /> Drinking Fountairi�.. Boiler <br /> � Floor drain �` Refrigeralion <br /> _ Grease trap �� Woodslove <br /> Roof drains ' � Olher c ,� u N�r <br /> 1 �(hQ! tMClj.{,�iJc�� SNOLc�L �l�1cwA f� Z. N � l-'kG aa <br /> — — — 1 <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined this application and know lhe same to be true and correcl. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or noL The granting of a permit does not presume I <br /> to give aulhority to violate or cancel the provision of any other state or local Iaw regulating construction or the peAormance of <br /> construclion.Pu b I am authori�ed by the owner of ihis propedy to pedorm lhe work for which application is made and I comply with the i <br /> State Con 6ctor Law 18.27 .;` and 296.200 WAC. <br /> J�N t 2, �xoo E, � <br /> Signatur f Ow er/ContraclorlAuthonzetl Agent Dale <br /> i <br /> y i <br />