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DEC-22-2010 22:16 FROM: <br />TO:14252578857 P.1/1 <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.everettwo.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM — <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />PERMIT 0 <br />LEGAI I LOT NO, <br />BLOCK <br />TRACT OR SUBDIVISION 4 <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />M\Chr, 4-4- ISo -?qb E� S� Ltkao0 Ws--7 0 -r2f <br />oQ R <br />TENANTNAME <br />ONTACT FOR PERMIT PHON <br />U2s Asa mi <br />.� <br />E-MAIL <br />PHONE <br />uQ�rQa' �l(.Ia EvP,ryrsM wEW �} �Vtrt� <br />CONTR. LI ENSE <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTTRACT PRICE OF WORK <br />Electric Gas _Other <br />/ aD ' <br />lfL <br />WORK DESCRIPTION <br />lCr U Qicb Cvrnr CJL <br />PLMBING <br />MECHANICAL <br />NO. TYPE Or FIXTURE OR ITEM <br />NO. TYPE OF FIKTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />rj_ <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water healer <br />` <br />Kitchen sink d disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />CluUtas washor <br />,� <br />Clothes dryer <br />�. <br />Water healer <br />Range flood <br />Sink(sarviowbor/mop/etc.) <br />Exhaust fan <br />_ <br />Dackflow provontor <br />Hoot pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boller <br />_ <br />Moor droln <br />Rofrigeratlon <br />_ <br />Grease Imp <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETI LOCAL SALEB TAX CODE IS 3109 <br />I hereby eeritify that I have road and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this typo of work will be compiled with whether specified heroin 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 />constru on. That I am outhorizod by the owner of this property to perform the work for which application is made and I comply with the <br />State on actors Lew 10.21 RCW and 206.200 WAC. <br />S791 re of Own on mcto//Aul onzod Agent Date <br />