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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 DEC 3 0 2005 <br />,i- 425-257-8810 - FAX.125-257-8857 - www.everettwa.org b� <br />APPLICATIONS ARE ACCEPTED FROM 8AMTO4PM CITY OF EVERET <br />SITE ADDRESS q*2 �✓ PARCEL TAX I.D. # PERMIT III�e <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CfTy1ZIP PHONE <br />F12U-D M"-VA' P0-3CYA 92-174 oP-- 972'�2 _ <br />TENANTNAME <br />CONTACT FOR PERMIT PHONE <br />pg-r--D Iv "e-p— <br />I ftAAj24— LAw9-E;4 1cj--- <br />CONTRACTOR �ES.t-F ��GG pje,rJq ADDRESS 27ov Ids *E SCITY21 A PHONE <br />MiE '_,_ �04M _77 <br />G'+� <br />CONTR. LICENSE # <br />Y I.-- <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />Electric _ Gas Other <br />3/ ecly <br />WORK DESCRIPTION <br />Zn15-1�11.L. B-yv� �LUS!>t MoL��.fT->=A Nam.-aTl cd/R�✓�^'�- <br />G� � s 167� ,¢014-1>/-.i/,, "7-vc.LY s COFFC-6 .. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gasrange <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backfiow preventer <br />— <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that 1 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 peril does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That 1 am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State�C%ofntraclorkLaw 18.27 RCW and 298.200 WAG. , <br />'��� <br />Signatu erlContractodAuthonzed Agen at <br />t 1 <br />I <br />