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10/19/2010 TUE 16247 PAX ©001/001 <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.ovorettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.O.A PERMR k <br /> �"sr ��J bb�6 � 35oavv yti Q0 L7 <br /> LEGA LOT NO. BLOCK TRACTOR SUBOM9KIN <br /> DESA. __ <br /> OWNEN <br /> AP <br /> _ CITy/LIP <br /> TE2(ANr. t �MAr� .._ Z52( 5 710 Sr'Sl� �u6QETT GI9aZ0 3`�LS"3<(� /� <br /> TENANT NAME I CONTACT POR PERMIT PHONE <br /> Uzf-��(-� (J � <br /> �ll^� E-MAIL <br /> 'L25RYnAbT51�" "-SII CITP/Z1P-- -- --DNbA <br /> g1 VF_ R AmII LLL '7111n L2o* S1 . �^' " I MounitetceICef0.14 '11N: K�5 '771.113`1 <br /> CONTR.LICENSEII <br /> USE OF BUILDING MEAT SOURCE I CONTRACT PRICE OFWORK <br /> sclrk, xGas_Other J <br /> WORK DESCRIPTION <br /> GiK ���N�Lf CE{AdJ�� 0� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM NO. TYPE OP FIXTURE OR ITEM <br /> TWlot A1C-air handling units <br /> _ Fonr;vd air cyctems <br /> Bathtub <br /> Uapiping <br /> Lavatory(worth basin) <br /> Shower _,__ Watt er healer <br /> Kifchen sink A dlsiwsAI GBG r <br /> _ Dishwasher - Gacange <br /> lenge <br /> ango hood <br /> Clothes washer RClothos dryer <br /> _ Water laslor _ Bong <br /> _ Sink(serolrnlbar/mopinlc.) _ Exhaust Ian <br /> _ Dacknow proventer _ Unit <br /> pump <br /> U <br /> Urinal <br /> _ Drinking Fountain _ Dollar <br /> tor <br /> heeler <br /> rallon <br /> Flnor drain _ Ro do <br /> GreAso trap Woodmlove <br /> vo <br /> Houl drains — Ulher_(a. <br /> Other .— <br /> CITY OF BVERETT LOCAL 8ALE9 TAX CODE 19 3105 <br /> I hereby cedltly that I havo read and examined thin application and know the same to be true and mrroct. All provisions of laws and J <br /> ordinaces governing thls type of work will bo complied with whelhor rperolhod heroin or nnt.Tire granting of a permit does not pronums <br /> to gHR authority to Notato or canLel tho provialon of any othor state or local law moulating construction ur the performance of <br /> cnnstrucllon. that I am authurVnd tow"0r <br /> of IN property to porform tho work for which AppIICRaon Is made and I Comply wllh the <br /> Slate Contractors L d 29 200 WAC. <br /> Slgnellura of V Conlrarlo ul zotl nl c / al V <br /> �.. <br /> Chu e� QA'✓ Mem" <br />