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Sep-23-10 03:32P P.O1 <br />. . . _.._�( . _.. . . -. -. .. <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 />— APP�ICATIONS ARE ACCEPTED FROM 8 AM T04 PM �j �.'�,�_,�d_ <br />SITE AODRESS PARCEL TAX I.p. # P MITtl <br />3_� c� ti � �.v __ J— _._ .. � � ��°.9- ��� <br />�tc;A LOT NO. BLOCK TRACT OR 9UBOIVI910N 7t <br />uEst:. <br />OWNER �� 4�bRESS �� CIYYI I � PHONE <br />N►�sn�,�K.� r ��y u( _ _ . _ �'3 / GJI��GJ �U q�� Yzs <br />TENANTNAME I CONTACTFORPERMIT � PHONE <br />�l. EdAAIL <br />CONTHACT H 'T 4D $� � CITY/ZIP aaNE �� <br />�kc �nebgk sI5' '3 L � l Fi U.,�-li 1�r/ y'i� i `/ <br />CONTR. LICENSE 1t <br />�u�-�o h� s� o`_L. kZ. ... <br />..zs.z yo/ / <br />USE O�U� iNG I — tIE,�T SOURCE GON7RAC7 PRICE OF WORK <br />� —__ �ler,iric �as Othr.r I ��7- ��O �� _ <br />—L. <br />WORK DESCRIPTION <br />�Z��c�-�r <br />PLUM <br />�J�S n o �- c,��n�- <br />NO. � ivPE OF fIXTURE OR ITEM <br />Toilei <br />PaihWb <br />L2va�ory (wash basin) <br />Sliower <br />Kilchen sink �C dispuS:al <br />, . Dishwasher <br />, Clothes washer <br />Wale� heil6f <br />, ,. _ Sink (service/badmopietc.) <br />Backflow preventer <br />Urin21 <br />Drinking Fuuntain <br />Floor Urain <br />Gre�se tr,ap <br />Roul drnins <br />other <br />N0. <br />3.�°a <br />�� wEn ,fiss� <br />� MECHANICAL <br />TYPE OF FI%TURE OR ITEM <br />A/C - air handiiny unils <br />Forr.nd air syslems <br />_ Gas pipinp <br />_ Water heater <br />Ga� lireplace <br />_ Gas ran�e <br />_ Clulhes dryer <br />Ranpe hood <br />_ Exhaustfan <br />Heat pump <br />llnit healer <br />_ Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAI. SALES TAX CODE IS 9105 <br />I hr.n:by ceritify thal I ha�e read and ex2mined this applir.:ition :end knuw lhe same fu be lrue 2nd corror.L NI provisions ol laws anU <br />orAin:�r.r.s gnvr.rninp this lypu uf wurh wil� be complioA with whr.lhr.r specified herein or not. Tho pranting of :i permil dues nul presume <br />to [�ivr. authonty lo violate u� C:ifli.el lh@ pr0�i5i0i� Of flny othRr stote ut 1uc8113Y� fCglllallilfl COnS�fUGtinn rn ihe peffufrn3nC8 UI <br />r,nnstrur.lion. I'hat �m • lh ired by the owner o� this propr.rty to periorm Ihe wurk lur which applica�inn is m�dr. and I comply wilh lhe <br />5�?tn Crnilr. , o La�v RCW and 2y6200 WAG. <br />, � � <br />. !y ,r /o <br />Sipn, ro ot Own " ntmctor/nulhonzed Ayenl % �( ato <br />