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MAY-17-2�05 �7:38 FRDM: TG:14�`2578857 ?. 1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, FVER[TT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857 —www.evor?ttwa.org 5 � f � �6 5 <br /> APPLICATICi:�ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS ^ PARCEL TAX I.D.M PERMI7# <br /> 3[Z� U�4 ( t`tv�P_ OaS�� 27d I Q i�J`- .35 <br /> LEGAL LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER ADDRESS p„�„ CItt21P PNONE <br /> U�l�. ��6i/�1'QQU 3 (Z �'/o �.t. o <br /> � � Ti�I< lr� �c £e��.e� tc/� �L��39 zG � / <br /> TENANT NAME CONTACT FOR PERMIi F+HONE <br /> �'�'�,-e— I 1-1 ncl4 `�lm�viGz�cJ'� �2-�7 ? 0 3 2�'-& <br /> CONTRACTOR��J 1_ �',�^ '�` noURe55 ciTvrziv PHONE <br /> r� c._..,._.7 � y�-z��-1Y'-✓�°�d��/*-�J <br /> CONTR.UCENSEM�A _ry_�I�rn� (�Q � � Z$Z �U() <br /> /r�l J T U �a-�f4 t/� �9 <br /> USE OF BUILDING HEAT SOURCE � CONTRACT FRICE OF WORK <br /> �� Electric ^Gas Other ��` ^ <br /> — — � <br /> WORKDESCRIPTION ��� ��GL� <br /> q�✓ � ��� r-�-� <br /> PLUMBING MECHANICAL <br /> NO. TYpE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ Toile� A/C–air handling units <br /> _ Bathtub Forcedairsysfems <br /> _ Lavetory(wash basln) Gas piping <br /> _ Shower � Wulenc�aler <br /> ,_ Kilchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas rango <br /> _ Clolhes washer Clothes dryer <br /> _ Laundry lray Range hoed <br /> _ Slnk(scrvice!bar/mopletc.) E�aust fan <br /> _ 6ackfiow prevnnter Heal pump <br /> _ Urinai Unil heater <br /> _ Drinking Founlain Doiler <br /> Floordrain — <br /> _ Greasetrap Rehigera!iun <br /> Roof dralns _ Woodstove <br /> =I �1he I = Other – <br /> CITY OF EVERETT IOCAl SALES 7A7C COOE IS J105 <br /> I hereby cenlity lhat 1 nave reatl and examineA Ihis applicaticn and know the same to be tr�a and cortect. All provlsions of laws and <br /> ord�naces governing this lyps o(wo,r will be complied with whelher specKad herein or no1.Tno granling nl a pennit doas not presume <br /> to give aulhority lo vlotale or wnccl U�e provislon ot any olher state or local law regulating conslr�:cUon or Iha perfortnanca of <br /> construction.7hat i am aulhonzed by the owner o(Ihis prt,peny to pedorm the+vork for which appiicalion is mado ond I eomply wlth the <br /> Slale Co tractors LaAw 18 RCW and 296.200 WAC. <br /> ��C� �pV12 ���7 c�� <br /> si��ure o� wner.,ontractorlAuthorize �enl Date <br />