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MqR-7-2005 08:36 FROM: <br />T^'14252578857 P.3 <br />PERMIT APPLIGATION <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 />APPLICATIQNS ARE ACCEPTED FROM 8 AM TO 4 PM -!1EBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE AD�RESS <br />I.EGAL LOTNO. <br />G'cSC. <br />C�A'NER <br />�a-1 Q �'d �� <br />TENi1NT WAME <br />CbNT3AC O <br />c,�lY`I�' � <br />co, m icer�se a <br />�1 �f!-( r <br />U:E OF B�JILDIN <br />WOF'K <br />�_ c� <br />NO. <br />I Toilel <br />�_� Bathtub <br />I Lavatory (��< <br />i Shower <br />Kitchen sink <br />Dishwasher <br />Clolhes was <br />_ Laundry tra� <br />SinK (servia <br />Urinal <br />Drinking Foi <br />Floor draln <br />Grease trap <br />Roo( drains <br />Other . <br />Lb � �'''' s4TJ� <br />— BLOCK <br />s�s.s 9�os <br />PARCEL TAX� I.D. # <br />TRACT <br />9��fE <br />CONTACTFOR <br />� �� <br />��� AU�RESS <br />� i�,rz � �i�7r.vuc( <br />� l / f`3n-jac�f <br />PLUMBING <br />'Pc OF FIXTLRE OR ITEM <br />i basin) <br />disposal <br />r <br />ar/mop/etc.) <br />onler <br />� <br />��.ac J t <br />CITYIZIP <br />� � � qd«F <br />3� �� <br />PHONE <br />�~7����Y <br />PHONE <br />y�� � � aa � Z�d-�-z«� <br />HEA7 SOURGE I CONTRACT PRICE OF WORK <br />�Electric _ 3as,� Other <br />�4� �U���� <br />N0. <br />� �-� Z� <br />� � <br />MECHANICAL <br />TYPE OF FIXTURE OFi ITEM <br />A/C - air hand:ing units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />R2nge hoad <br />Exhaustf;n <br />Haat pump <br />Unil heater <br />Boiler <br />Refrigeratian <br />N'oodstove <br />Other <br />CITY Of EVERETT LOCAL SAlES TAX CODE IS J105 <br />I heroby ceritify lha I have read and eaaminod this app��icatlon and know }he samo lo be true and correct. All provf,ions of laws and <br />ordinaces governin this rypo of work will be complied with whether specified herein or not. The granting of a permit does not prasume <br />lo give aulhority to Iolale or cancei the provision of any olner state or Iocai law regulating wn:lrvction or �hs pertormance of <br />construction. That I m authorized by the owner of lhis property to perform thy work forwhich applicalion is made and I comply wilh lhe <br />Slate Contr ctors L w 1t . RCW and 296. 00 WAC. � <br />� � 3/� /o •— <br />