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FEB-10-2005 09:38 FROM: <br />TO:14252578857 P.1 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />2 — l� `b CJ <br />425-257-8810 — FAX 425-257-8857 — www.everettv/a.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS 7-3z� Cvml� <br />(xJY 39 �It��//.�Q�3�j <br />PERMIT# <br />LEGA LOT N0. <br />BLOCK <br />TRACE <br />DES <br />OWN fRn ADDRESS L}L•/CITY2IP PHON�� e <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />7 3z <br />CONTRACTOR W R-J �' ��/ ADDRESS CITY/ZIP PHONE <br />r ` y <br />2 CZylcc <br />CONTR. LICENSE # 204,V7o0 <br />WA-fKl C797lo� <br />USE OF BUILDING <br />I <br />HEA'i SOURCE <br />I CONTRACT PRICE OF WORK <br />l` <br />Sr✓e-1 <br />_ Electric iGas _ Other <br />r <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIX WRE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Shower <br />= <br />Gas piping <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes drys, <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/badmop/etc.) <br />Exhaust fan <br />_ <br />Backflow prevenler <br />_ <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />_ <br />C-inking FOLnlain <br />_ <br />Boiler <br />Floor drain <br />Refigeraticn <br />Grease U-p <br />_ <br />Woodstove <br />Roof drains <br />_ <br />Other <br />Other _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read ar, l 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 complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel die provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property tc perform the work for which application is made and I comply with the <br />Stale Con actors Law 7 RCW and 296,200 WAC. 2 L <br />�4 ; �o� 1� - 7?6 32H� <br />_&b,tb <br />Sig.. lure o OwnedContractor/Aulhorize Agent Date <br />4 <br />