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'��7. '�'- <br /> ' �` � g�O(�-`6�� -?35 l <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES ! <br /> 3200 CEDAR STREET, EVERET7', WA 99201 ,.-/--- ' S��� <br /> 425-257-8510- FAX 425-257-8857-www.everettwa.org�' b <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM i I�� .� UG^ � / <br /> SITE ADDRESS PARCEI.TAX I.D.# P[RMIT 8 <br /> loal '1 - IR�" Rve SE � ioaoyoc�ao ioc� �C=v'-��oo�— <br /> LEGAI lOTNO. BLOCK TRAGT <br /> DESC. <br /> OWNER AODRESS GITYlZIP PNONE <br /> Dr C�a�'Ie5 Kivn � a�f7 - I Q`k' I�,.e. S� �ve�tff i.JA q82og <br /> 7ENANT NAME CONTACT FOR PER�AIT pHONE <br /> Dr �y,ax-les �.'.'im P.��k Nar-t- �-12s �-V�a — <br /> CONTRACTOR /�I� JC J��� l /,�� AODRES i CITY2IP P�Z�^443^$7�� <br /> (�) � r <br /> CONTR.4iCEN557t RICK���OpuNG oZ�ZO7 /`Sb �i2J'1�� 1 JQMmamiS� WFF �IY07� <br /> U3�OR 6UILDING MeA!SOURCE CONTRACT PRICE OF WARK <br /> Den�'a� ���h� C _ Electric K Gas_Other ��� D�a I <br /> WORK DESCRIPTION <br /> ins-�a��a.`�16i'1 ��" Y1e� C�ILC'�[�Of�C 0�'l�y <br /> / <br /> �-I� exhausf -�'etn vPx��S a n��! __ , <br /> PI.UMBING MECHANICAL <br /> NO. I 7YVE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling units <br /> _ Bathtub � Foreed air systems <br /> _ Lavatory(wash besin} Gac piping <br /> Shower Water heater <br /> _ Kltchen sink 3 disposal � Gas frepiace <br /> _. Di511WA5hZl' ^ Gas range <br /> ,.` Clothes washer Clothes dryer <br /> I.aundry tray Range hood <br />� � Sink(service/bar/mop/etc.) � Eehaust fan <br /> _ Backflow preventer Heat pump <br /> Urfnal UNt heater <br /> Drinking Fountain 6oiler <br /> _ Floor dfain Refrigeration <br /> _ Grease trap Wcodstove <br /> _ Roof drains � other�t,u.{w cXK.�h.I�/ <br /> Otner <br /> CIlY OF EVERE77 LOCAL SALES Ta%COOE IS 3105 <br /> I hereby cantlfy thaf I havr�raad and examfned this applicalion and know Ihe eamo to hc truc and corrcct. All pmvis�ons of lews end <br /> ordinaces goveming tr,is type of work will be complied wilh whether speclPed herein or not.The grantinti oF a permit doos not presume <br /> l0 give authority to violote or Cancel lbe provision ot eny othet state or locai law regulating constniction or lho paAormance of <br /> Conslruclion.That I am aulhorized by the owner of this pmporty tn pPrform fhr.wnrk tnr whlrh appllcalion is made and I comply with tha <br /> i Stato clors Luvf 18.7.7 RC nd 296 .00 WAC. <br /> u � �� � ii�%d6 <br /> ignature of OwnoqContractorlAuthnrized Agent Date �- <br />