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�LMJ-13-2005 08:02 FROM: <br />T0:14252578857 P.1 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />32D0 CEDAR STREET, EVERETT, WA 9820 i <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />/--�3 --a5 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br />SITE AODRESS <br />CD i 1 �i (.l1 �e-�-rnar�e <br />LEGA LOTNO. BLOCK <br />TIIACT <br />PARCEL TAX �.D. X <br />� 3/ /enna o3/0 <br />,P��S �F'Sly %�%e�mD�Pj 4� � — <br />TENANT NAME CONTACT FOR PERMIT <br />' I .�-1�Kf4 �o>'77QUi/�� <br />CONTRACTOR i . la� <br />w <br />CONTR. LICENSE • <br />t,ll �J'Nlc <br />USE OF BUILDING <br />� <br />&j� AODRE33 GfTv/zIP <br />Z�'�`'Thomrl�c. �c 4J <br />��ior� �'�Q GvL 9d? <br />I HEATSOURCE � <br />_ Eledrk �as _ Other <br />NIT • <br />/, /-, / — <br />�7,J'77o 3Z�� <br />rnvnc <br />ao(v Z�a- �/7cv <br />CONTRACT PR10E OF WORK <br />V 1RK DESCRIPTION <br />�a.r � �s ux�h�-� ���r�� <br />N0. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basln) <br />Shower <br />Kitchen sink G dlsposal <br />OlShwa6nef <br />Clolhes washet <br />Laundry Iray <br />Sink (service/badmoplelc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />^ Roof drains <br />Olhcr <br />N0. I TYPE OF FIXTVRE OR fTEM <br />AIC — air han0lirg units <br />Forced air systems <br />Gas piping <br />Watvr heater <br />Gas 6replace <br />Gas ren8e <br />C�othes dryer <br />Range hood <br />Exhauatfan <br />Heat pump <br />Unit heater <br />Boiler <br />Reirigerotion <br />Woodstove <br />Other <br />CITY OF EVERETT LOGAL SALES 7AX CODE IS �105 <br />I hereby ceritify that I have read and ezamined thls applleatlon and kn�w the same to be Irue ana correct. AI� pmvisions ot laws and <br />ordinaces goveming ihis type of work will be complied with whether spec�ed herein or not. The greNing of a pertnit daes not presume <br />to give authonry 10 vlolate or cancel the provision of any other state cr local law regulatlng consWcticn or the pertormance oi <br />consW r.tion. That I am authorized by Ihe owner of this properry to pr.rfortn Ihe work for whicn application is made and I comply with the <br />State CanVacWrs Lav�1827� RCW and 296200 WAC. <br />�i.,, ,A LV-hm,,,,_� T 1�13�� <br />