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p L�C� ONIC PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> JUN 0 6 2006 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br /> CITY OF EVERETT APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM (, -09-0,6 <br /> SI EIADDR Ss PARCEL TAX I.D.# PERMIT# <br /> III vh ett 5M I I Snao CD -vo`1 <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 'a -1 ' v n n <br /> CONTRACTOR &(,(y <br /> (,(y/� tCt0(1J`Cr61 n ADDRESS CITYIZIP PHONE <br /> -406ereC <br /> CONTR.LICENSE# GUr14_ W / <br /> USE OF BUILDING (] JW �A HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION .Jc P <br /> NdrU—f , t t(\&*I64vat' cef4cr `brsp(ay 5;9n , �/uSh �u4c/ vY�ounkc�, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet _ A/C—air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> _ Kitchen sink 8 dispo*al _ Gas fireplace <br /> _ Dishwasher — Gas range <br /> _ Clothes washer Clothes dryer <br /> Water healer _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> _ BackBow preventor _ Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain _ Boiler <br /> _ Floor drain _ Refrigeration <br /> _ Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cerilify that I have read and examined this 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.That 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 18.27 RCW and 296.20D WAC. <br /> Signature of Owner/Contractor/Authodzed Agent Date <br /> Z <br />