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09/09/2009 WED 15144 PAX 3606686140 Canon Ir�iJ004/005 <br /> ( <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.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADRppJ)ESS PARCEL TAX I.D.A 1PERMIT 0 <br /> LEGAL LOT NO. 13LOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> ER ADDRESS CITY/Zip PHONE <br /> )O-d G 'Loo-C 9ZQ 9t'Zf!•. FUy)•re.0A (rzs.3yugsto <br /> TENANT NAME CONTACT FOR PERMITr PHONE _ <br /> U-Ce E-MAIL �JtCt 2 �� <br /> ;ase �UPe 54z <br /> ONTR.LICENSE M <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric ,Gas_Cer <br /> WORK DESCRIPTION <br /> \t�.Sk�QQ �(��Wxc�rri C-�cS�cxnat�. l�b�'�1.�;n5 dd4r,Dl.��r^Q <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> — Toilet A/C—air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryor <br /> Water heator Range hood <br /> Sink(service/bar/mop/etc.) Exhaust Ian <br /> Backtlowprovenler ( Heatum <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> 1 hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinates governing this typo of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or tante'the provision of any other stale or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this properly to perform the work for which application Is made and I comply with the <br /> St t ntracty LOW j,8.27 CW and 290200 WAC. <br /> S gnature of awner/Contractor/Authorizedgent ate <br />