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Rx Date/Time JAN-03-2'd07(WED) 10:27 d25 ?.57 8857
<br /> 01/03/2007 ll q3 FAX 425 25� 4gi7 P. 001
<br /> -�-.�.fi,.,p�„r� EVERETT PERMIT SERVIC
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<br /> CI7'1( OF EVERETT PERMiT SERVICES `_6 3 -07
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org �
<br /> APPLI�A'i IONS ARE ACCEPTED FROM 8 AAA TO 4 PM (51�1� �,,�,,.,r-(b
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<br /> SITE ADDRESS -
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<br /> TENANTNAME CONTACTFORPERMR PHONE
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<br /> CONi�ucTOR 44��r,��� ��,,��.���ti �,�,���qpDRE55 CrtY21P PHONE
<br /> CONTR.LICENSE#`�� � C' ��Z2C , _ ,.'. .l , t:. ,. . .�
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<br /> USE OF BUfLDING HEATSOURCE :ONTRACT PRICE OF WORK
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<br /> WORK DE8CRIRTION
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<br /> PLUMBING hAECHANICAL
<br /> NO. TYpE OF FIXTUfiE OR f7EM N0. TYPE OF FIXTURE OR REM
<br /> ; Toilet A/C-air handlin un?is
<br /> Balhtub — 9
<br /> v Lavatory(wash basinj Forced air systems
<br /> Shawer � Gas piping
<br /> _ Kitchen sink 8 disposal — Weter heater
<br /> Dishwasher _ Ges fireplace
<br /> � Clothes washer _ Gasrange
<br /> � Water henter Clothes dryer
<br /> I Slnk(servlcelbaNmopletc.) � aenge hood
<br /> Backflow preventer _ E�aust fan
<br /> � llrinel Heat pump
<br /> � Urinking Fauntain _ Unit heater
<br /> � Flaordrain Boiler
<br /> _ Grease trap _ Rafrigeratlon
<br /> Roof draing Waads(ove
<br /> Other � Other
<br /> CITY OF EVERE7T LOCAL SALES TAX COGE 19 3105
<br /> I hereby ceriG(y that I have read antl e�camined thia appllea9on and know the same t�be true and correet Ail provlslons of laws and
<br /> to§ive authorit'y�p v��ol t o�eancel he provls on oIf any hehstate ar o�pl laweregulatlng constructl nnor the performanec of presume
<br /> nstrudion.�Th t I am aufhorized by the owner of thls property�o peRorm the work for which applicatio�i Is made and I comply wlth lfie
<br /> S e Cc;itractors Law 18.27 RCW and 248.200 WAC.
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<br /> S�gnature of ONmer/Contracror/Authouad Agent Date
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