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Aug-04-Q5 01 : 17P �otal Energy 5099469383 P.06 <br /> �-- --- ------ --_..._--�— <br /> PERMIT APPLICATlON <br /> CITY OF EVERETT PERMIT SERVIC S � �I l �a5 <br /> 3200 CEDAR STREET, EVERETT, WA 9�201 <br /> i 425-257-8810- FAX 425-257-3851-vnwf.everetlwa. rg n/� '7 <br /> '�' I c5b � � 0 /� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT&CREDIT CA S ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 11� V ������ CO�I Ca -t�e�t�" <br /> LEGAL LOTNO. BLOCK TRAC7 <br /> �ESC. 5'R9-- CL 0. � C�.� <br /> OWNER AOURESS CIN21P PHONE <br /> �enc1 `�a.sk �av�tr�n�es 20�4 I I ��i�^ 5}r � _ � Qa �-�1`�.2-0 /� <br /> TENANT NAME CONTACT fOR PERMIT PH NE <br /> �� �� (��.�� ������ _ 9�1,�u� <br /> CON7RACTOR � A�bRESS ITYIZIP ' PHONE <br /> To�,�cqU I'Ao�no.�r�r� � <br /> CONTR.LICENSEtl o. . qq3 a � G��y� I <br /> �[SiAl.EM1o�lln►J� � \ � � — � <br /> USE OF BUILDING HEA SOURCE COi�TRACT PRICE OF WORK <br /> � \ _Electric `�Gas_Olher I � �� <br /> � I <br /> i WORK DESCRIP ION -`'-� ��^ p���- <br /> � •��_��� '� / <br /> T 1 �.. o�. — C�(Z� s C�n�. �� <br /> ?LUMBING M CHANICAL <br /> i NO. TYPE OF FIXTURE OR ITEM NO. TYPE F FIXTURE OR ITEM � <br /> � Toilet A/C-air handling u ils I <br /> Ba1Mub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shewer Water heater <br /> Kitchen sink 8 dienn;ai Gas freplace <br /> Dishwasher Gas ranr,e �. <br /> _ Clothes washer Clothes dryer � <br /> _ Laundry tray _ Range hood � <br /> � _ Sink (service/bar/mop/e1c.) Ezhausl fan � <br /> i _ Backflow preventcr _ Heat oump <br /> Unnal Unit heater <br /> i _ Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> _ Grease trap ^ Woodslove <br /> � Roof dreins Other <br /> I _ Olher — — — <br /> __CITY OF EVERETT LOCAL SALES TAX I ODE IS 3'I05 I <br /> I hereby ceritify ihaf I have read and examined this application ar.a know the same l0 6=true and corr t All provisions of laws and I <br /> i ordinaces goveming this type of work will Le complied with whelher specifed herein or not. The orenti of a permit tloes not presume <br /> � give aWhority to violale o� cancet ihr.provision of any other sWte or local law regulatirig construction r Ih�pei'ormance of j <br /> imsiruction. That I am authonzed by Ihe orvner o(this property lo perform the�mrk fer which appiicati n is made and I comply wi[h�he <br /> 5� te Coniractors La� Z7 RCVJ and296.Z00 WAC. <br /> C � � F �'`� <br /> �' l � L) (l� ' �� y U`) _ <br /> I5ignature of Otim rlCon radodAuthorized gen Date I <br /> �_._--_ --__.-- .____—_-___ __—_ -_ _.--___ _ — ._.—_ _ __ _.__ _ _J <br />