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� PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES ', <br /> ?200 CEDAR STREET, EVERETT, WA 98201 I <br /> � 425-257-8810 — FAX 425-257-8857 —www.evereUwa.org � <br /> �� I <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> /� / <br /> 630014errill Crc�ei; Pazk:•:ay �H0407.00301500 (j'�V� C�' � <br /> LEGAL LOTNO. BLOCK TRACT � <br /> I DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ^:acl�ing[on Hnidir.nr, 6D0 U�iver�it'i SC Buite 2850 Seattle, `:A ��e-G61-5300 � <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> i:o:l: koYce Raynee Hale �06-5-5-9700 I <br /> CONTRACTOR "`i-�'a:1Or�:� ``'��'�:`1Dj ADDRESS 1221 '_nd Ave N CITY/ZIP r�«� PHONE =��-��5-9%r,n '� <br /> P;d, 95C32 �, <br /> CONTR.LICENSE# HEEU�InCL005B.7 <br /> II USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK �I�, <br /> ..ecail sn��� I _Electric '�_Gas_Other , _9,5pp . <br /> IWORK DESCRIPTION I..=ta11 I11 new rooftop i./c unit and 111 ne:a exhuast :an.� �. <br /> I i <br /> � <br /> � <br /> i PWMBIN3 MECHAhICAL � <br /> �'� NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM I <br /> �� Toilet - A�C-air handling units I�� <br /> Balhtub Forced air systems � <br /> Lavatory(wash basin) _ Gas piping � <br /> Shower Water healer �I <br /> � Ki:chen sink 8 disposal Gas fireplace <br /> I Dishwasher Gas range <br /> I Clothes washer Clothes dryer <br /> I _ Laundry tray R; ge hood <br /> I __ Sink(service/bar/moplelc.) ? Exhaust tan , <br /> IBackflow preventer _ Heat pump , <br /> �� Urinal Unit heater � <br /> ��, _ Drinking FouNain Boiler � <br /> I Floor drain _ Relrigeration � <br /> i _ Grrase trap _ Woodstove il <br /> Roof drains _ Other _ <br /> j _ Olher — -- 'I <br /> I — — I — _ <br /> � CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 j <br /> I, I hereby cerilify lhal I have read and examined Ihis applicalion and know lhe same to be true and correct. All provisions of laws and I <br /> '�. ordinares governing this type of work will be complied with whether specfied herein or not.The granting of a permit does not presume <br /> �, to give aulhority to violale or cancel the provision of any olher state or local law regulating conslruction or the performance of <br /> '�, construction. That I am aulhorized by the owner of lhis property to perform the work for�vhich application is irade and I comply with the <br /> �. State Contraclors Law 1827 RCW and 296200 W�C. <br /> Vl �� � � L �c�c�� ��1J <br /> ', Signature of wnedGonlractor/Aulhorized Agent Da e � / <br /> —_ /� <br />