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. Jan. 30. 1014 11:05PN� No. 1687 P. 1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 96201 <br /> 425-257-8810- FAX 425.257.8857-www.everattwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 30--A4 <br /> SITE ADDRESS r- PARCEL TAX LD. PPE,�RMITa <br /> LEGA OTNO. �GDLOCK S TR3TORSUBDIVISIONI `V` I�C'' O�� <br /> DESC. <br /> WNADDRESS CITY/ZIP PHONE <br /> Ju&Wii scats. as abbe 425355 o(DI3 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE L- <br /> 4Za <br /> �� _ I� E•Ma '�G'�'�Jlf'� Ilfil�l i'lti <br /> PDRESS <br /> Cm' ea rtq )II 1415 r3r " C--vtedi LIS7,01 it 2,5 h <br /> 0ONTR•L i 9E t_ 0 „�11 <br /> USE OF BUILDING y 1 I — NEAT SOURCE' I CONTRACT PRICE OF WORK <br /> p-„ ,;,z hs, I o 131 3b <br /> WORK DESCRIPTION 4 A Ip <br /> nn 1L 1�m �- , <br /> I h b�Z(,t,{ I lea+ Pu rx,� r 'v12,( <br /> PLUMBING MECHANICAL. <br /> NO. TYPE OF FIXTURE OR ITLM 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 healer <br /> _ Kitchen sink a disposal Gas fireplace <br /> _ Dishwasher Aas range ' <br /> _ Clothes washer Clothes dryer <br /> _ Water heater Range hood <br /> Sink(serwce/bar/mop/etc.) Exhaust Ian <br /> _ Backflow preventer i, Neat pump <br /> _ Urinal Unit heater <br /> Drinking Fountain Boller <br /> _ Floor drain Refrigeration <br /> Grease Trap W001 ve <br /> — Roof drains Olher .tr <br /> - _ Other <br /> CITY OF EVEMETT LOCAL DALES TAX CODE Is 3105 <br /> 1 hereby termly 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 type of work will be compiled win whether specified herein or riot.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.Ther I em authorized by the owner of this properly to perform the work for which application is made and I comply with the <br /> Stale Contractors Law 18.27 RCW and 298.200 WAC <br /> IffL. ' <br /> ignatu r <br /> of u"of/vIC aclOf/AUIM 1 gent Date <br />