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M7Jan. 9. 2012 10: 12AM No.-2556 P. 2/4 <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 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.a PERMIT# <br /> 261- 58t`' S1- SW I Tn X io► - o ► Cl <br /> LEGALt LOTNO. BLOCK TRACT On SUBDIVISION <br /> DESC. <br /> OwNth AO RE8S CITYIZIP PHONE <br /> 00r0lyr) 2612 ST'S SVg82.03 425470045 <br /> TENANT NAME CONTT,A,C1T,FOR PERMIT PHONE 4 -259 to(0 to <br /> PHONE - <br /> /�yw I �1� E-MAIL <br /> ii1)el (nL. 14\CJ gY�lyw�{.� era 701 ` ZS ZSq to(0tokv <br /> CONTR LIC <br /> 6V, � <br /> USE OF BUILDINGI HEAT SO RCE CONTRACT PRICE OF WORK <br /> Electric Gas_Olnvr 2 1 O <br /> WORK DESCRIPTION <br /> {r/(1"A"�� m 1 C <br /> VL. OIQJ "(N-rnaC-L_ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C-air handling unils <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower _,-, Water healer <br /> Kitchen sink 8 disposal _ Das fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> _ Water heater Range hood <br /> Sink(service/ber/mop/otc.) Exhaust fan <br /> BackBow prevemerHeat pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain Boller <br /> _ Floor drain _ RsIrlgeration <br /> _ Grease trap Woodstow <br /> _ Roof drains = Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 5105 <br /> I hereby cerltlfy that I have read and examined this application and know the same to be ir,:o and correct. All provisions of laws and <br /> ordinates 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 slate or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application Is made and I comply Win the <br /> State Contractors Lew 18.27 RCW and 208.200 WAC. <br /> �wC <br /> Ignalu o1 ner/Contr r/ Ulhonze ale <br />