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Nov. 3. 2009 9:28AM No.2012 P. 2 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — vAvw.everetWa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I 1 -� <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />'j {Zd 2 %D(A1 2002ooaoo MC)CI l i -Q <br />b r�es�n <br />LEGA LOT NO. BLOCK TRACTORSUBDIVISION# <br />DES C. <br />OWNER ADDRESS CITY/ZIP PHONE <br />P&kkQ CnS r,Orrn T)kA Lots 2( uT Ave fJG U►r A <br />, U-Jjf <br />TENANTNAME CO�NTTACT FOR PERMIT PHONE as3-R'la SfAfoY <br />S"t� V—%1A r•.lirlf�'GS IU 1y,4Af InlQ ll�1(_%i1 f�hR(L/N E•MAILCi ir7�v7�dP1W_Y�r 7 <br />CONTRAC OR AD SS S� Nw µ�IP 9aWIHON. f3"pi�S�OW <br />Ernes Pd,l Ake /nc S/a8 1i O <br />CONTR.LICENSE# C/1`)EKAr�/olSi3L _ <br />' I J <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />tz/Eloclricnn_�� Gas <br />I <br />I aoco — <br />''—Other <br />WORKDET�JPTIO_N <br />PLUMBING <br />MECHANICAL <br />ND. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C— air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Waterheater <br />_ <br />Showar <br />Kitchen sink & disposal <br />__ <br />Gas fireplace <br />Dishwasher <br />Clothes washer <br />Gas range <br />Clothes dryor <br />_ <br />_ <br />Water healer <br />Sink (service/bar/mop/etc.) <br />y <br />Range hood <br />Exhaust fan <br />_ <br />_ <br />Baekuow preventor <br />Heat pump <br />Unit heater <br />Urinal <br />Drinking Fountain <br />Boiler <br />Floordraln <br />__ <br />Refrigeration <br />_ <br />_ <br />Crease trap <br />__ <br />Woodslove <br />Other <br />Roof drains <br />_ <br />_ <br />Other - <br />CITY OF EVERETT LOCAL SALE5 TAX CODE IS 3105 _ <br />1 hereby ceritily that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordlnaces governing this type of work will be complied with whether specified heroin 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 arc, aWl»rued by the owner of this property to perform ilia work for which application is made and I comply with the <br />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />1 \� 3 iu`1, <br />Slgnah o10wner/ rector/Authorized Agent Date <br />P -CAI <br />