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MRR-1-2005 10:41 FROM: TQ:14252578657 P•1 <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 - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SRE A�DRESS �R I� �e f� �l D�PARCEL TAX I.D.N��/ � �O���O� <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> p CfTYRIP N <br /> J�t� IU.cfSn„ zR�6 ��.r� I�u�A- ��a,�f- �-f Z�yr18 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> L�nr�A ���x1� �r��3z�� <br /> CONTRACTOR��� ��.I�� ADO SS CITV2IP PHONE <br /> ��'.�,b �a. 2r,G 2�� S�`zco <br /> coN".UCENSE�w�f,I ,�� f��l„/� Q�Qf <br /> IK J U3 <br /> U9E OF Bl11LDINO HEAT 30URCE � CONTRACT PRICE OF WORK <br /> S�r` I _Eledric �Gas_Olher I 3! �� � <br /> WORK DESCRIPTION <br /> C��►s � Ei�-s �{'vrn 4c�. c�4 n � c�o �1 <br /> , <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR REM NO. TYPE OF FUCTURE�R ITEM <br /> Tolkt A/C—air handling unik <br /> Bathtub = Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Showar _ Waterheater <br /> IGtchen sink 8 disposal _, Gas fireplace <br /> Dishwasher Gas range <br /> Ciothac wasM1er _ Clothos dryor <br /> _ laundry lray _ Ronpe hood <br /> Sink(servkelbadmopletc.) _ Ezhaust fan <br /> Backflow prevenler __ Heat pump <br /> Urinal _ Unit heater <br /> Drinkin9 Fountain _ 8oiier <br /> Flaordrai� __ ReBlgeraqon <br /> Grease trap _ Woadstove <br /> Root drains _ Other <br /> Other — <br /> CIN OF EVERET�LOCAL SALES 7AX COOE IS 7105 <br /> I hereby ceriUfy that I have read and examinad thla application and know Ihe same to be true and correct. All provisions of laws and � <br /> ordinaces goveming lhis type of work will be complled with whether spec�ed hereln or not.The grantlng o(a pertnit does nal presume <br /> to give authoriry to vlolate or cancal Ihe provislon of any ather state ar local Ww regulaUng conewctlon or the pertortnance of <br /> consWctlon.Thaf I am authorized by the owner of th�a property lo perfortn the work for wnlch applicat(on is made and I comply with the <br /> State C�cWrs La .27 RCW and 296.200 WAC. / <br /> (.ttGCc CiL�.�� �J 3 I ! (OJi <br /> Sign re Owner/ oMrecror Au e gent ate <br />