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Jol. il. 2D12 11 : 16AM �°. �'25 �. ' <br /> 1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98207 <br /> 425-257-8810—FAX 425-257-8857—www.everellwa.org <br /> APPLIGATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.k PERMIT# <br /> �o n ar �q8Za3 t'r�ao�-- �►� <br /> LEGAL LOT N0. BLOCK TRACT OA SUBUIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> I�loyd DanKu lot� Grov�nDr �I �t`g20.� 3_1�03�g3�a2� <br /> TENAN7 AME CONTACTFORPERMIT PHONE <br /> �}Z5 259 (o(cloW <br /> ��ti'J-1� e�+a� <br /> � Cm �i-�ncJ, n�- �wiS 6maduaaa-j G-,/ Qg2U � �t2525� !�(�66 <br /> CONTH.LICEN3n��'i11�M G�, 1 <br /> U I l 1�\ U-1 J �T <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE Of WORK <br /> Electric �Gas_Other I q �3( � <br /> WORK DESCRIPTION rhGC.G 1�2D ,'�' 3 4� ��� � �Y15"I�l�� .3 �1.5 <br /> Run9us p�pt�q -b� , �p 5 <br /> �ire�IQc� �as {�Urv�t+ta.. ���unIUe55 N?.o <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OH ITEM NO. TYPC OF FIXTUF�E OR ITEM <br /> 7oilet _ AIC—air hand!Ing units <br /> gathiub Forced air systems <br /> Lavatory(wash basin) s„�L Gas piping <br /> _ Shower � Waler healer <br /> Kilchen Sink S disposal Gas�ireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> � Slnk(service/badmop/elc.) Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> � Drinhinp Foun�ain _ Boiler <br /> Floor drain Ratriperation <br /> = Groase trap Woods�vas�UrY1�(�_ <br /> Roof drains � Olher=� <br /> Other <br /> � — — <br /> CITY OF EVER6TT LOCAL SALES TAX CO�E IS 9f 05 <br /> I heraby cerili(y that I have read and examined this application and know lhe same to be true 3nd correcl. All provisions of laws and <br /> ordinaces goveming lhls type ot work will bo complied with whelher specified herein or not.Tl�e pranting ot a pem�it does nol presume <br /> to give nuthority to violate or cancel the provlslon of any oU�er stale or looal law regutating construclion or the perfarmance of <br /> consiruction.Thal I am authorized by Ihe owner of this propeny to pertorm the work for which Lppllcatlon Is made and 1 comply wilh the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> 1��� �aa.�t�1�c �� I 1�I �- <br /> Signature oi ner/ContracrodAV aAzed Agent Dala <br />