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Oct. 18. 2011 10: 50AM No. 1164 P, 3 <br /> ( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES ' <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-6810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS AR8 ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.k PERMIT A <br /> 1 V� ��U '�`� <br /> LEOA LOi NO. 9LOCK TRACT OA SUDDIVIBION• � � '^'� <br /> DESC. ��� <br /> OWNEfl DR CI 21P � <br /> � e,rru Sarn aso� 2`130 �navi� �I�d �v, w� �'g�o t <br /> TENANTNA E I CONTACiFORPERMIT PN Ni �/�/ <br /> _—. , '�'25 2`� �V IV <br /> e•Ma� <br /> Gm a�; nq 1�c. 1415 43 rOc�lc.t�Ju-� �! ag?,Q I 425 2.5� (of� <br /> CON7R.L�CENSE M^M��,������ <br /> 1.1�� TL <br /> USE OF BUILpING I — HEAT SOURCE I CONTflACT PRICE OF WORK <br /> Electric ��as_Other �g�g� `3 <br /> WORK DESCRIPTION (�u� �^ C I , i�/1 ^� � ���1a� <br /> T` H.J �i�.f ul <br /> 1v1S��� 2 qA5 lY�S2.�5 <br /> PLUMBI MECHANICAL <br /> NO. TYPE OF flXTURE OR ITHM NO. YYPE OF FI%TURE OR ITEM <br /> __,_, Toilet _ AIC—air handling units <br /> � Belhlub Forced alr systems <br /> _ Lavatory(wesh basin) � Gas piping <br /> Shower Water heater <br /> Kitchan slnk 8 disposal ,� Qac fireplace <br /> Dishwasher _ Gas ranQe <br /> Clothes washer _ Clothes dryer <br /> Water healor _ Rang�hood <br /> ,,,_,_ Sink(serviceThadmop/etc.) Exhausl fan <br /> BackHowpreventer _ Heatpump <br /> Urinel _ Unit heater <br /> T Drinking Fountain Boiler <br /> � Floordrain ^ Retrigeration <br /> Greas9lrap � Woods�ove <br /> Roof drains � Other <br /> � Other <br /> CITY OF HVEHkTf LOCAL 9ALES TAX COOE IS 3105 <br /> I hereby coritify thal I heve�ead and examined this application and knoW the same to be true and correCt. All provisions of lews and <br /> ord�naCes govarning thls type ot work will be complied wilh whelher specMied herein or not.The granting of a permit does not presume <br /> Io give authorlty to violate or cancel lhe provieion of any othar state or locel law repulaling consiruction or lha pertormance ot <br /> construction.That I am authorized by the owner ol this property to perform Ihe work for which app�icalion Is metle e�d�Comply with the <br /> Stala ComraCtorS Law 1827 RCW and 296.200 WAC. <br /> ►7 b�� �a.u.e,�s �o �l g << I <br /> Sipnat re ot Owner/ ontraclor/Authorized Agent ale <br />