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i <br /> , <br /> � PERMIT 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 TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT# <br /> fo�o M�R�U. �.�dl• 28�02 00 0 l 300 7l�-5 <br /> LEGA LOT NO. BLOCK TRACT OH SUBOIVISION Y <br /> DESG Zp �'apwp�{ QeJ'(� <br /> OWNEfl ADDRESS CITY2IP PHONE <br /> 1�6F}I1��N l��l�'.� Ld.G. ldJD��f�� ST �prT.E�WA . ZL�(/ (Or3'ti,P.�00 <br /> TENANT NAME CONTA FOR PERMIi T� PMONE <br /> 1`{EE AI�RI� I �P�J L �?�(' LM11 Ap43�q'S �t.D(v 3?5•2553 <br /> CONTRACTOq ou�� ADDRESS CITY2IP PHONE <br /> � 321�o i)8T� �11� s+E. �vue� 1�1+ `�Z5 �-J Oco <br /> CONTR.LICENSE p /� D� QA�yq <br /> �I D•���� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �j�AM�,�� _Eleciric �as_Olher � ��6� �OV � <br /> r�rl'r"� <br /> WORK DE,qCRIPTION - � <br /> lN�t�ctL �J�h�710EL � ���f'I� �'� ��� <br /> �F{111�+G�—'p-11►�rU3f►uG=�-E]:�G`��-�� }�l}11�Jw1;'"�Itt.--'SpR1U�s � �'�Ali <br /> -t'� h A M S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OH ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> 8athlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas lireplace <br /> Di;hwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(serviceibadmop/elc.) _ Exhausl lan <br /> Backllow preven�er _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Bailer <br /> Floor drain Relrigeralian <br /> Grease irap _ Woodstove <br /> Raaf drains O�her <br /> Other <br /> CITY OF EVEReTT LOCAL SALES TAX CODE IS 9105 <br /> I liereby ceritily that I have read and examined Ihis application and know�he same lo be true and correct, hll p;ovisions of laws and <br /> ordinaces governing this lype of work will be complied with whether specilied herein or nol.The grantinc�o(a permit does not presume <br /> to give authority to violate or cancel ihe provisiun of any other state or local law regulating consWction or the peAormance of <br /> consiruction.That I am authorized by the ownei of lhis property to perform Ihe work for which applicalion is made and I comp�y with the <br /> Slal�tois l �v 78.27 RC and 296.200 WAC. <br /> � 0 5•01 • Ort <br /> �� <br /> Signat e of OwneuContractod thonzed Agent Date <br /> r Z� <br />