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FROM :E�ergreen Stdte Hedt R 9� FRX N0. :4252596660 \ Nov. 19 2010 09�54RM P1 <br /> t <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 9F3201 <br /> 425-257-t3810—FAX 425-257-II857—www.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM B AM TO 4 PM f���� ...� <br /> SITE ADDRESS PARCEL 7AX I.D,p pERM1T# <br /> a-I �A1ti- lM�O/l��!o <br /> I.EGAL LOT NO, BLOCK TRACT OR SUBOIVISION Y <br /> DESC. <br /> OWNER AD E TV I PM NEc a,r),,,,a�c� . <br /> I�D� �, l�e.o�.e�z- �-III Ruc�(.,,-Fe.11�V �/e%e:.t�. � 8?-o I ��3?, <br /> TENANT NAME I CONTACT FOR PERMIT PHONG�}�j �Fj,3� <br /> �� `7/' r' E-MAIL CQJ'1��f'.S51h1�1.� <br /> ��Yi�—'� VHbI�� <br /> ��� �rv�a_-io�D �d 2� �Cu.�P►a�e. ij�tt�. <br /> CONTR.UCENS'e A <br /> e�reYas s o��.o-� �sa�� <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> ��,�� _EloUric �Gas_Othcr a,r�QQ� <br /> WORK DE9CRIPTION <br /> �15'�l � �^-r�� <br /> PLUMBING MECHANICAL <br /> N0. TyPE-Of FIXiURE OR ITEM NO. TYPE OF FI%TURE OR IT6M <br /> _ Tollot „ A/C–alfhandlinguni�s <br /> _ BathW6 1 Forcudairsys�ams <br /> _ Lavatory(v.ash basin) Gas i in <br /> — PP 9 <br /> Shower WaWr hoalor <br /> _ Kilchen sink 8 disposnl Gas Flroplaco <br /> _ Dishwash�r Gasrangc � <br /> _ Clolh�s wesher ` Clothes dry�;r <br /> _ Woter heater „ Ranpe hood <br /> _ Sfnk(sorvico/bar/mop/otc.) 6rhausl fan <br /> _ 6ackllow pruvontor Heat pump <br /> Urinal Unit hr.alar <br /> ._ Drinkin� Fountain � 8olter <br /> _ Floor draln Refngeration <br /> _ Grease trap Woodstovo <br /> Roof drains _ Other <br /> A OthAr� <br /> GITY OF EVERETT LOCAL 311tES 7A%CODE 19 5105 <br /> I horoby cortify that I hovo roud and oxaminod this eppllcollon and know tho same to be lrua and corcect. All provisions of laws and <br /> ordir�ances govevning ihis type�a(�5vrk will ho campfod wilh wholho�speclfled heroin or nol.The granting of�portnit doas not p�esume <br /> to give nuthortly to vlolnte or cancel the provlsion of ony olher stale or local Inw regulating constrvclion or the pedormence of <br /> conslruction.Thal I am auUiorizod by Ih�owner n(�hiti prnp�Ay tn periMm the wrork for whlch application is made and I comply whh the <br /> 'talo Contrectors Law 10.27 RCW nnd 29(3.200 WAC. <br /> . �1-,�� � i� �q_� b <br /> S�gnature o wner ontrncroNAut ionz gont Dato <br />