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10/10l2007 10:02 fAX 425 257 8857 EVE�.ETT °ERNIT SERVICES �001/001 <br /> � <br /> PERMIT APPLICATION <br /> ' CITY QF EVERETT PERMIT SERVeCES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.evereflwa.org <br /> PPLICA710NS ARE ACCEPTED FROM 8 AM 7'O 4 PM <br /> SITE ADDRESS PARCEL TA7C I,D,A� PERMIT# <br /> �I�"Hi,e9� �{, S�`1 E� 00 y 9C.U� o'�. O - b <br /> LEG LO7N0. BLOCK TRACi <br /> DESC. <br /> OWNLR AOORESS P <br /> l,cX.�� �PzoPc�t7cs c���Rcrr ccc l�,�o �; Ba�+�-p ��,u� G�t�crC� 9/zt�3 <br /> TENANT NAME CONTACT FOR PERMIT � PHONE <br /> �(',� C��-1 �-�'�"c I ( U `�k�►�C(�S ��42.SCr.�I ( <br /> CONTRAGTORG�.'l�� - ��� -�� ADDRE55 up GITY(LIP waPHO�IF,,,,�/^ <br /> C(.�.-1�55��`�11"lU� �zZ SZ, Cl'Sr �z�eEt+rA, �t r��r `�" I <br /> CONiFt.LICENSE i1 � �v��),�Q���l <br /> ,CiC/ f <br /> U3E Of BUILDING HFJ1T SOURCE CONTRACT PRICE OF WORK <br /> �1 � � <br /> / �i� ,� , (���' _Electric _Gas_Olher p � �: <br /> _LL � i <br /> WORK DESCRIPiION � j'��.(..(. 3ei, + ' j/F �!ti/ <br /> � PLUMBING MECHANICAL <br /> NO. 7YpE OF FUCTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 7oilet A/C—airhandling units <br /> Bathtuh � Forcedairsystems <br /> � Lavah���(wash basln) � Gas piping <br /> � Shower � Waferheater <br /> _ Kilchen sink d disposal Gas fireplace <br /> _ Dishwasher � Gas range <br /> ( i Clotnes washer = Clothes dryer <br /> Water heater Ranga hood <br /> ,_ Sink(servicelbadmop/etc.) Exhaustfan <br /> _ 6ackfiow preventer Heat pump <br /> Urinal ^' Unitheafer <br /> Drinking F�unlain Boiler <br /> _ Floor drain Refrigeratlon <br /> _ Grease hap Woodstove <br /> Roof drnir�s � Other <br /> Other <br /> CfTY OF EVERETT LOCAL SALES TAl(CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicstion and know lha same lo be hue and correct. All provisions of lews and <br /> ordinaces goveming this type of work will be comptietl with whether speclfied hereln or not The granting of a pertnit does not preyume <br /> tu give aulhoriry to vlolate or r,antel ihe provision of eny oth0r state or local Iaw reguiatlnp W nstNCtion ar the peAortnance of <br /> consVuction.That I am authorized by the owner of thls property 1�perform the work Tor which application is made and I comply with the <br /> a e �lract rs�La 27 CW and 296.200 WAC. <br /> - h � � l�` Il-D� <br /> i alure /Contractor/Aulhotlzed Agent Date �/ <br />