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11/13/2007 TUE 17:33 FAX 4)001/002 <br /> rt • t <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 PARCEL TAX I.D.# I PE IT# <br /> 2-1 ao 1.�;()T-.;R 11\\IL. I56E 411A011-7) ':: .� !6r�A 1 1 /3 .71/ 052- <br /> LEGAI: LOT NO. ' BLOCK TRACT OR SUBDIVISION# <br /> DESC. 5 ATTAC + (BCS'' ( 4?ss/i -....c cJ 0 <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> L► rset, ,y,1V iCks L‘X., 210-/- CDW=°AU•G 5Uti. )'Z re W.i. q S-2z1 <br /> TENANT NAME CONTACT FOR PERMIT PHONE ,q 741141" <br /> C f 1 ft"r1"—' I <br /> NA .c..gu<v. OC"-,4iD1 ) E-MML Jerzi `!te �kl 0 .4-+; <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE js CONTRACT PRICE OF WORK <br /> , w <br /> ^� � 1 2Ct <br /> Electric ^ Gas_Other I' . " <br /> WORK DESCRIPTION cows'y all - iptw (t ccv s!`'ti pup or 4 2, i6Eve'L W G(zALE <br /> PAt .4e 1 ..A3 re ) 45`•LOFT"A PIS) • S•n P E L /r'L APT's AND <br /> to-2. Leve:IN-0K) k4m.ts Pkc,r7, . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> )< ToiletA/C—air handling units <br /> `.k Bathtub C Forced air systems <br /> Lavatory(wash basin) _ as piping <br /> Shower 'X_ ater heater <br /> fie! Kitchen sink&disposal as fireplace <br /> S4' Dishwasher as range <br /> Clothes washer X Clothes dryer <br /> Water heater X .Range hood <br /> berg(smice/bar/mop/etc.) X Exhaust fan <br /> Backflow Oreventer Heat pump <br /> Urinal it het <br /> Drinking Fountain Boiler <br /> Floor drairi Refrigeration <br /> Grease tra. _ Woodstove <br /> `' Roof drainv___ Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces 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 viola e or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I uthorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contra 1 27 RC a7^-t .200 WAC. <br /> ure of Owner/Contractor/Authoriz-- Agent Date - <br /> T ' <br />