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PERMIT APPLICATION � <br /> CITY OF EVERE7T PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everethva.arg <br /> APPLICATIONS ARE ACCEpTED FROM 8 AM TO 4 PM -DE81T 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITEADDRESS � PARCELTAXI.D.N ��P''�^'A�4 "�AY PERMIT <br /> �D�J>�J �9+h �VE. s•�. �0?j IvFs -F�. Ec dtv�d.ed �.q�m aale •f �_ j1 <br /> indiv�dM _ 000-oo •o� / <br /> LEGHL 40TN0. BLOCK TRAC7 - ooSqa- 000-oo�_eo <br /> DES�. U(�l+ � I O�S GO o �f i� ES�YiP'FtAV� A'�'dchcc� <br /> OWNER AD RESS CITY2IP PHONE <br /> in c�re. ot : �040� R�rpor}� 415� - <br /> SiLVEt��AKE Pro�ccE LLC �.aw�e„cc M. Na��,�,�EZ Gvcre�} WA .qgZpq ��4 '� o <br /> 7ENANT NAME CONTACT FOR PERMIT PHONE <br /> Dr. DoN DcL�1IVUEFZ I (1�R1 SAlE6A �OFFICENJRAPS,iN�. 425•952-5-i93 <br /> CONTRACTOR T 6.� qDDRESS CRY21P PHONE <br /> CCINTR.LICENSE�I <br /> USE OF BUII.DING HEAT SOURCE CONTRACT PRICE OF WORK <br /> MtXEp 1,�SE <br /> Un1T �03 ' Wali�ir� M�d•Glihi _Eledric �Gas_Other gp,000,'o (est�ma�c <br /> WORKDESCRIPTION CavSTQUc.T SNTER�OR IMPRovEMENTS -fo 17�`(o54• FT. LFASE� <br /> SpAcp �R uSE q5 A MEDI!AL �WALK YN C ARE - c�INIL : WL�4DINC� PARTITlDNS � FIrtI5HE5 <br /> MEDi[A� F_QUIPMENT i �iXTNRES � ��UMBMdC� � {�v.4G. � LIGHTINC-� WIR�NC� ANQ <br /> IMPRD�/E,MENTS A5 SHOwN Oni ARqw�Nczs . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM NO. TYPE OF FU(TURE OR ITEM <br /> 2 Toilet A/�-airhandlingunits <br /> Bathtub Forced air systems <br /> �,� Lzvatory(wash basin) Gas i in <br /> Shower — P P 9 <br /> Water heater <br /> Kitchen sink&disposal Gas fireplace <br />� Dishwasher Gas ran�e <br /> _ Clothes washer C�olhe•s:lry�r <br /> undry tray Range!�u�d <br /> � Sin servicelbar/mop/elc.) Exha�.;�!ian <br /> _ Back prr,venter Hea:pump <br /> Urinal Unit heater <br /> Drinking Fou in oiler <br /> _ i'bord2in friyt:ration <br /> Grease trap W stove <br /> Roof drains � p�h . <br /> Other — - <br /> CITY OF EVERETT LOCAL SALES 7A7(CODE IS 3105 <br /> I hereby ceritify ihat I have read and examined this applicalion and know the same to be true and cortect. All provisions of laws and <br /> orcJinaces goveming this type of work wili be complied with whether specified herein or not.The granting of a pertnit dces not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulaUng consWction or the perfortnarce of <br /> construction.Thai I am authorized by the owner of this property to perfurm the work for which application is made and I comply with the <br /> Slate Contractors L 78.27 RCW and 296.200 WAC. <br /> �I,� �����c_ �/9�d5 <br /> Signatu e of OwnerTContrac�oqAuthonzed A�ent Date <br /> Ilv <br />