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Nov. 21. 7.U11 10:38AN No. 1768 P. 6 <br /> � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEOAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX A25•257•8857—www.everetiwa.orp <br /> APPI,ICATIONS AHE ACCHPTED FROM 8 AM TO 4 PM I� —o� I�II <br /> SITE ADpRES3 PARCEL TAX I.D.0 PEpM1T 11 <br /> 1 g �, I - C7�-f io <br /> LEGA LOT N0. BLOCK TRACT OH SUSOIYISION N <br /> DESC. <br /> OWNE D 1 1 N <br /> Lolo�osStro�d I�ie R�� a�t�r�'I�I�RQg�� `4Z533q 139 I_ <br /> TENANT NAME CONTACT FOR PERMIT PHONE���.����L�G <br /> ,{/�J�J1Jv�.� �� RMJ <br /> E•MAIL <br /> C.�rn i�ecc�nct I nc. 14►� �( rux�:b�9 1 �{Z,�'l.Sq �,fo�+ <br /> CONTR,�ICENSfiM 5R <br /> (:1�1 <br /> USE OF BU�LDIN(i HEAT SOVRCE CONTRACT PRICE OF WORK <br /> �Eteciric _Gas_Other S2Z 3, �l.� <br /> WORKDESCRIPTION 1�5.�11 'L -by� 1�lQ'��ry�a� G:�r htund.leX' <br /> � <br /> PLUMBING <br /> N0. TYPE OF FIXTURE OFi ITEM N0. TYPE OF fl%TURE ON ITEM <br /> Toiie� A!C—air handlinp units <br /> � Balhtub _ Forced air cystems <br /> _ Lavalory(wnsh besin) _ Gas piping <br /> Shower Waler heale� <br /> Kilchen sink 6 disposal _ Gas tirap�ace <br /> pishwasher Gaerango <br /> Ciothes washer Clolhes dryer <br /> Waler heater Ranpe hood <br /> Sink(serviceibar/moplelc.) Exhausl tan <br /> � 6ackllow preventer ,� Heat pump <br /> Urinal Unit healer <br /> Drinkinp Fountain _ Bouer <br /> Floot drain Rafrigoralion <br /> = P Wootlstov 1_- �_J <br /> Hool dra ns � Other Q� I�cI.YILi�e✓ <br /> Other <br /> CI7V OF EVERETT LOCAL SALES TA%CODE IS 7�05 <br /> I hereby c0rilily thal I have read and 0xamin0d thls application 3nd know the same to be irue and correcl. All provisions ol laws a�d <br /> prdinaces govarning thie lype of work wlll be complled with whether spetilled herein or not.The granting ot a permit does nol presume <br /> lo give auihorily lo violate or caneel�ha provision ol eny olher slate or loaal law repulatinp construmior or Ihe peHormence cf <br /> construction.That I um authorized by the owner of this propeny to perlorm Ihe work lor which applicalion is made and I comply wilh Ihe <br /> Slale Contraclors law 18.27 RC and 296.200 WAC. <br /> i�e,bb'�� ��.�..� I � �+� <br /> Slgnature Owner/Contractod Ihorizetl ge ate <br />