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PERMIT APRLICATION ��1� G, [�(�C�� �, <br /> CITY OF EVERETT P�RMIT SERVIC� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 SEP 2 5 2005 � '� <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org"'CITY �� � " I <br /> p Fn3ineerirfl p�VERF;�.. . . <br /> APPLICATIONS ARE ACCE. TED FROM 8 AM TO 4 PM `,r�,�,� ubl���e� <br /> SIrT�E�A,/DDRESS �j PARCEL TAX I.D.# �P/E�RMIT# p� /� <br /> 7•J(��-t �t� St . rVE�'L� �''k �l L� I 004 q�IDGYX�7Jr� Y/ 1 (�i �— (l V <br /> L[GAL LOrTT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. I S i��T �� LE-G i D N �'h�k -�-�i�I�J �jar�En.�7%,_ D �2 <br /> OWNER ADDRESS CITYI2IP PHONE <br /> 2c�ti� �Nt 2futc 56 �o Zoc��' �. S�UI. 8--3'�7 �`!i�►Jweo�p ��$b �bl$ <br /> v._ � ._ r �.B <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��, va,-�i� �n � �+�� �i a�� — 43I -- 89� 1 <br /> E• AIL <br /> CONTRACTOR ADDRESS ITYIZIP PHONE <br /> A1»��so;a t-1��P�AC� Il �o 6��RUN-��D �Ev���r , �y,�p� qg2o1 <br /> CON'iR.LICENSE p i�2�� � .� �p_ ), ` 1r <br /> l I `'1�O 7 <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRIr,E OF WORK <br /> �FNTkt Pf��P��2T� , <br /> 32� �°'� <br /> ��INC�L� '����5'� �.Eleclric _Gas. _Other � � � <br /> WORKDESCRIPTION {L(, - <br /> I N S�ti i �I 1'� �'L� I N`a-(z��lt9-1 O �l <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handling unils <br /> Dalhtub _ Forced air sysleins <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler hea�er <br /> I(itchon sink & dispo�al Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Walcn c�alcr Ranc�e hood <br /> Sink(servicelbarimop/elc.) Exhausl fan � <br /> 6ackllow preventer Heal pump <br /> Urinal Unil healer <br /> _ Drinking Founlain Boiler <br /> Floor drain Re(rigeralion <br /> Greasn, trap Woodslove <br /> Rao(drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify that I have read and examined ihis application and know lhe same lo be true and correcL All provisions o(laws and <br /> ordinaces goveming thia type of work�vill be complied wilh whether specified herein or noL Thc granling of a permit does not presume <br /> lo c�ive authoriry to violate or cancc'lhe provision ot any other state or local law regulating construclion or lhe peAormance of <br /> construclion. �hat I am authorimc: by Ihe owner o(this propeAq to peAorm;he work tor which application is made and I comply with lhe <br /> Sfalc Contraclors Law 1 .27 RCW and 29f.200\NAC. <br /> � f <br /> �:�a.�.cu e<��� .,�3 — c�' — 2� <br /> SiynaWre of OwnedContraclor/AulhorizeA Agenl Dale <br /> ---- — J <br /> — a; <br />