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FROI1 :Evergreen State Hedt 8 q;� FAX N0. :4252596660 � Jan. 24 2007 08:12AM P1 <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 /> APPLICATION5 ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRES$ PARCEL TqX I.D.M PERMIT it <br /> �/3 5' Ri��c� Wi 70/- �`� <br /> LEGA LOT NO. BLOCK ' TRACT <br /> DESC. <br /> OW ER ADDR 8 CRYIiIP PHONE <br /> �x�rv �vss �/3iy /�1iG�.�: p,p �2 g�o3 ,25'3 3,�sr <br /> TENANT NAAAE I CONTACT FOR PERLIR PHONE <br /> CONtRACTOR ADDRE99 CRY/ZIP PHONE <br /> EZtti2GR�la�' � S//�t"/Hs7K'G <br /> CONTR.LICENS N Z/2v /��/�/cl9� f�j'. �5��/ ZS� ' �I�y <br /> �M li 5`J! .Z3�OT <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /���.1�!?i%7/n� �EletMc �Ges_Othcr �� `�v 4. <br /> WORK OESCRIpT10N <br /> /h���- G.vs �'**R�✓/palE� /f/1p�nc. flL�7�'�i'L , F�'��� /iiTi�'s <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR IiEM NO. riVE OF FUCTURE OR REM <br /> „_., Toilel /UC-airhandlinpuNts <br /> _ 8nthhib % Forced eir systems <br /> _ Lavalory(wash basin) Gas piping <br /> _ Showar i � Waler hoate� <br /> . Kitchen sink&dl,post�l _ Gns fireplaca <br /> _ Dlshwashor Gasrangc <br /> _ Clothes vlasher _ Cbthos dryer <br /> _ Laundry tfay Range hootl <br /> , . Sink(serJice/borlmop/etc.) �_ Exhaust fan <br /> _ BackBow brovonlor Hoat pump <br /> _ Urinal Unil huator <br /> ___ Drinkinp�ountnln Boiler <br /> _ Floor drai� _ Rafrigeration <br /> _ Grenso tr�p Woodstove <br /> _ Roof tlraii1s Other <br /> Other • -- - _ <br /> _... . .�-- — .. <br /> CITV OF EVERE7T LOCAL SALES TAX CODE IS]105 <br /> I hereby ceritlty t�et I hava road and ezaminad this application and know Ihe seme;o ba we and corroct. All provisions ol lawe and <br /> ordinaces gover�ing lhis type of work will be complied with whelher specifiad herein or not. The granting oT a permlt does not presume <br /> to giva authority�o viulate or cancel lhe provlsion of any olher stale or local law reguloting conslruclion or the performence of <br /> constru�llo Th�l I am authonzed by the owner ol(his property to peAonn fha�wrk for wfiich applicatlon is mede and I comply with Ihe <br /> St te'Contro tor6 Lnw 7 RCW d 298.200 WAC. <br /> ��Zj� 07 <br /> SiBnaWre of OwnedContrec mhonzed Agent Da(e <br />