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Ffon:IAAC INC. <br />To:914252578857 031n5/2012 09:14 n`004 P.002/003 <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 <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />PERMITS <br />807 <br />QDD <br />LEGA LOTNO. <br />BLOCK <br />TRACT OR SUBDIVISION IF <br />DESC. <br />OWNER ADDRESS CrTYZP PHONE <br />✓��ETi ffOGlS/ti/G/� 27/l /5 '.1)(l�e �VetCN - y1,--303 <br />TENANTNAME <br />ONTACT FOR PERMIT PHONE <br />Al / 4 <br />E-MAIL <br />CORMACTOR ADDRESS ulfylz�w PHONE <br />CONTR. LICENSEN //t'�f{.`� BQ %"' Or7 11LV-70,3 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />✓Electrto ✓Gas Other <br />I <br />WORK DESCRIPTION //�'�t��. /�P�t-J CJ^—�.Lf �,t�I�T-Ul,.�' �• 'Pr-)V//fit / e-j <br />/it/&S ft7 CL(LYvJES (SEs /4 TJgcr�Cl� cvPy o�• seOP� G� uo.2 C OP�u� 9'!, <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR REM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C- air handling units <br />Bathtub <br />__ <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />K9chen sink 5 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water heater <br />Range hood <br />_ <br />Slnk(service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backgow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boller <br />_ <br />Floor draln <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />i <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and exam inad this application and know the same to be true and correct All provlslons of laws and <br />ordinates governing this type of work will be complied with whether specs led herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br />construction. That I ant authorized by the owner of this property to perform the work for which application Is made and I comply with the <br />State Conlractors w CW and 296.200 WAC. <br />ci 3-S=r7o/� <br />L <br />Sign tur of own e� onvactor/Aul onzo gent Date <br />