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11/�4/20E9 15:0E 088D01 PAGE 02/03 <br /> ( ( . <br /> P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SEFiVIC�S <br /> 3?_00 CEDAR S7REET, EVERETT, WA 98201 <br /> 425-257-8810- F.4X 425•257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM f/-- y-� <br /> SITE AD�RESS PARCEL TAX I.D,it PERMIT a <br /> �l(02o Lvcr rccr� wAy ooydl p� 0 500 (.' 9/�- �� <br /> L[GAL LOTNO. OLOCK TRACTOfiSUF3�IVISIONp <br /> DESG. <br /> OWNER ADDRESS CITYIZIP f�HONE <br /> Clec�.rchar�nel o�-4rloo,� 3�p� S�xah QJas Sa1-Ncp.,wa C2oto)cv82-3s3� <br /> �I��3�-i <br /> TCNANT NAME :ONTACT FOF PEFMIT PNONE 2U(o.lvBy•3£i33 <br /> C��a,� ch0.r��e1 o�+clOoC llepkher Merr;�� <br /> e.nnan.heG.-l-herrneruli c� <br /> CONTFiACT R ADO E�3 �4T���iaF7�Z, u�-Cnannel•co� <br /> lea.r- channel ouidoor 3�001 9ix+nA��9�f, `z�) �82-3�33 <br /> CON'fH.LICENSE#CGOICLgR11.00�1'-17.03 5�i+�' �'"'� � g�3`a <br /> F�/rr�a�- A�-s�ners 3t (��4�IH 8U <br /> USE OF eUILUING HEAT SOURCE CONTRACT PRI�E GF WORK <br /> AdYPX-1��`S�M� SigYl ^Eloctr�c �GasTOthor � aCX7•00 <br /> WOpK DESCRIPTION <br /> �Mol'�sl-i 9�gn �1-ruc-�ur� av�d G��iSprs���. aF at1 rk,n--t-onic: <br /> mGt-4-er1�1 1ec1cL1�� �r� li-lne, Cauni-y. <br /> PLUMBING NfECHANICAL <br /> N0. 'fYPE OF FIXlURG OR IT�M N0. TYPE OF FIX7URE OR ITEA7 <br /> 7oilo� FVC-air hxndling units <br /> Balhtub Farced air systems <br /> Lavalory(�vash basin) T Gas piping <br /> � Shower ^ Water healer <br /> Klichen slnk 8 dicposal � Gas liroplace <br /> Di,h�vasher _,_,_ Gas rangc <br /> Clo�hes washer Claihas dryar <br /> Water heeter Range hood <br /> Sink(servicelbnr/mop/etc.) Exhausl fan <br /> Backflow preventsr Heal pump <br /> Urinai Unit heaier <br /> � Drinking Fountain Boiler <br /> � Fioor drain Rolrigaratlon <br /> Greaao trap T `Noodslava <br /> � Hool draln, � Other _ <br /> � Otner <br /> Clri OF EVERETT LOCAL SALES?AX CODE IS 9105 � <br /> I hereby cerilify ihat I have read and examined this applicetion and know Ihe same to be true and correct. All pravisions of lews and <br /> orclinaces goveming Ihis type ot vrork Hill he complied with whelher specified hereln or noL The granting of a permit does not presume <br /> to givo authorily lo vioiato or cancel the provision of any olhcr slat¢or local law regulating constructicn or thrs puriormance ol <br /> con5iruc�ipn.That I am authorized 6y Ihe owner ol lhis propeAy to pedorm lhe work for which epplieation ia made and I comply wilh the <br /> Stato Contract�rs Law 1827 RCW and 296.2Q0 WAC. <br /> I—� _C'A �,� YYl Jr c�l l ���y�U�I <br /> Slgnalur�ot Ownor/COnlraCtor Authorizotl Agant ate <br />