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DEC-20-201i� 16:59 FROM:C81�1 HERTIIJG 425-745-1344 T0: 14252578657 P:2�8 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT pERMIT SERVICES <br /> 3200 CEDAR STFaEET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 I4M TO 4 PM <br /> SITE ADDRESS pARCEL TAX I.D.# PERMIT it <br /> ' Ou;n 1�r -7� <br /> LEGA lOTNO. BLOCK TRACTOflSUBDIV�SIONA <br /> DESC. <br /> O -H ADOryE53 CITY2IP PHONE <br /> Q�;be.�t �u�n�-t-� �Z4 Cravwn 'Dr E.ve��tt' ZC� �f-4S 825�- <br /> TENANT NAME I CONTACT FOp pERMR PHONE <br /> ^�'�/p �� �}2.5 25Q (cE6�6 ,�y <br /> '/-[is�CJ�.�i rLPE•MAIL^'b1lJF')IO E J'�I�L I ' � <br /> Ci�'1 N�A��=C45�'�' 1415 P�r'Qc�u3a� 5le.r��!-�$ZQ t '-k�Zs ZS C�66 <br /> CONTp.LICENSER /� � �(.,�y.�{� IhG <br /> t..t�l ttC�� � i <br /> USE OF BUIIDING ! — �HEATSOURCE CONTRACT PRICE OF WORK <br /> IElectrtc �Gas,_Other �o��� q ,Q Q <br /> WO DE5CRIPTION <br /> �l?i1 C�0.SIi 1�e '-1b �Uf�.CP, �� t t�Ua�2Y h��t�-�' `�' �(,"t,M� e <br /> 1�15�l l -�c��1 G�c� �4- 1�aa� h2c�-Qj'' <br /> PLUMBING MECNANICAL <br /> NO. TYPE OF FlXTURE OR REA! NO, TYPE OF FIXTURE OR IiEM <br /> Tollet AIC—air handling unlls <br /> Bathtub � Forc�dairsystems <br /> _ Lavatory(wash bazin) c� Gas piping <br /> Shower ,� Watar heater <br /> Kltchcn sink E�disposal ,�, Gas fireplace <br /> � Oishwasher L Gaz range <br /> Clothes washer Ciothes dryer <br /> Water heater _ Ranpe hood <br /> Slnk(servireJbadmop/etc.) Exhaust tan <br /> Bnck(iow provontar hieat pump <br /> Urinal , Unit lieater <br /> � Drinkinp Founlain Boiler <br /> Floor drain Refrlgeration <br /> Grease Irap Woaislove <br /> ROo1 drains _ Other <br /> Other <br /> Cf7Y OF EYERETT LOCAL SALES TAX CODE IS 3105 <br /> I hercby cerltity that I have read and examined this applieation and know the same ro be true and correct. A1I provlsions of laws and <br /> orolnacus governing this type of work will bo complfed with whether specifiad hereln or not.7he grenting ot a permit dces not presome <br /> to glvo nuiho�ity to violate or cancel the provislon of any other state or local law regulating constructlon or the perlormance ot <br /> constructlon. That i am auihorized by the owner ot this propehy to pertorm the work for which apptication Is made and I comply with the <br /> State Contr tors L�w 1827 1N and 296.200 WAC. <br /> ��t4. Qa_� 12 'ZQ •tZ� <br /> Ignature OwnedContractoflAuthorizecf agent Oate <br />