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MRR-28-2011 08:25 FROM:C&M HERTING 4z5-745-1344 T0:14252578857 P:2�3 <br /> � � <br /> PERIUIIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257•8857—www•everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM tU 4 PM 3 _ a °� -► l <br /> SITE AO�RESS PARCELTAX I.D.lt PERMITfl <br /> �Q�h�,,, - .�, /f�i/03-D � <br /> LEO� LOT NO. SLOCK TRACT OR SUBDIVISION A <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE IIz� <br /> �J� f �am �hP.�'m�n 15aq (.em{�rcl � 6Je.��20 f +-Nr1� z�5� <br /> TENANTNAME I CONTACYFOR PERMR PHONE <br /> E•MA1l <br /> CXY11-{� � InL 14-f5 ��a�u�a� Ev�X�" �175'?AI �P�zsz.S�9 �lofo� <br /> CONTA.LICENSE ^ ����O��p� <br /> L��n ri <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> I Etectric �Gas_Other �q5� <br /> WORK DESCRIPTION � <br /> ru n c�as L�-r�- -ta 1w+v�a�r haa-I�-�' , ran9 e , � f i r-e,plccce. <br /> PWMBING MECHANICAL <br /> N0. TYPE OF F�CNRE OR REM NO. TYPE OF flKfURE OR REM <br /> Toilet A!C—air handling u�its <br /> BatMub Foresd air systems <br /> � Lavatory(K�ash basin) � Gas piping <br /> ^ Shower Water heater <br /> � Kitchcn sink&disposal Gas fireplace <br /> � Dishwasher � Gas range <br /> � Clothes washer Clofhes dryer <br /> � Water heater RangO h00d <br /> � Sl�k(serviceroar/mop/etc.) _ Exhaust lan <br /> Beckflow preventer _ Hoat pump <br /> Urinai ` Unit heater <br /> —� Drinking FOUntain _ Boile� <br /> Floor draln Refrigsralion <br /> � Greasa trap _ Woodstove <br /> Root dralns Other <br /> OthCr _ <br /> CITY OF EVEHEfT LOCAL SALES TA7C CODE IS 3105 <br /> I hereby cerltiry that I have read and examined this application and know the same to be true and conect. Ail provislons of laws and <br /> ordinaces govemin 'his type of work wiil be complied with whether spec'�ed herein or no6 The g2ntinp of a permk does not presume <br /> lo glv2 flUthOflty IO late or cancel ihe provision o1 any other state or local law regulating construction ar the pertortnance of <br /> constructlon.That I am authorized by the owner of Ihis property to peAortn Ihe worfc for vrhich app�ication ts made and I compry with the <br /> StatG Contractors Law 18.27 W and 29n.200 W:.C. <br /> ����i��c 3 �a8 • � I <br /> :,Ignat � ot Owner/Gontrac dAuthoriz¢d Age t DSte <br /> r� <br />