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04/13/2006 15:49 3605682085 CORSTONE CONTP^CTORS PAGE 01 <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 PM 7 b6oq—o .(_ <br />SITE ADDRESS PARCEL TAX I.D. K PERMIT# O <br />IGOG lq �veSE, Ev�r�tt I tom.. -en, <br />LOT NO. I L•1.00K <br />TENANT NAME <br />CONTRACTOR <br />CONTR. LICENSE % <br />CONTACT FOR PERMIT PHONE <br />ADDRESS <br />CITYIZIP PHONE <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />_Electric Gas�,Othe- t szi.M <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet X 4 <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink R disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backtiiow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE 133106 <br />I hereby ceritify that I have read and examined INS 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 violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. 1-hat I am authorized by the owner of this property to perform the work for which application Is made and I comply with the <br />State Contractors Law 16.2' CW and 296.200 WAG. ++ r <br />