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SEP/21/2010/TUE 11:18 AM KENNELLY KEYS FAX No.4256706713 P. 001/006 <br />�Iw.a-Z«, b. �Rert w 3cabsr �,gRf1A-r�✓(„ nil <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 93201 <br />425-257-8810 — FAX 425-257-8857 — www.everattwo.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />—— --- _.------ <br />SITE ADDRESS <br />_.._... <br />PARCEL TAX I.D. a <br />PERMIT e <br />15-4 et0y� 5f' SW Ilk S, <br />��--- <br />LEGAL LOT NO. BLOCK <br />TRACT OR SUBDIVISION e <br />DESC. <br />OWNER CN.Te1CT07- 4 }• ADDR S9 I/ P PHONE <br />FrrA (�jATX1YfttA 1132 CwLh 501#a V;?04 3'1tr <br />TENANT NAME CONTACT FOR PERMSPHONE '2a(a—�7'L•abt{ <br />C'kirtis <br />n <br />�(IV �ATv?fItoCONTRACTOR <br />IAJ� /„J rGG //7//1LAS ATE p E-MAIL p� 9/� i0 j% <br />O W114 <br />CONTR. LICENSE 0 0J �1J <br />USE OF BUILDING <br />NEAT SOURCE <br />CONTRACT PRICE OF WORK <br />C 0"'DO <br />�EI"c —Gas —Other <br />I <br />I <br />WORK DESCRIPTION <br />22f.p(o EI; r SL $LA-s ���- �+j ..2x� FitnrnLb wpr4L. h <br />�— <br />PLUMBING <br />._ MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toile) <br />A/C — air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heeler <br />_ <br />Kitchen sink 6 disposal <br />Gas limplace <br />Dishwasher <br />Gee range <br />_ <br />Clothes washer <br />Clothes dryer <br />Water heater <br />Range hood <br />Sink (servireftr/moplete.) <br />_ <br />Exhaust fan <br />Backilow pmventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heeler <br />Drinking Fountain <br />Boller <br />_ <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodatove <br />Roof drains <br />Other <br />_ <br />Other--------------- <br />CITY OF EVERETT LOCAL SALES TAX CODE 19 3105 <br />I hereby certify that 1 have read and examined this application and know the some to be true and correct. All provisions of laws and <br />ordinances governing this type of work well be romptled with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or the provision of any other state or local law regulating construction or the performance of <br />construction, That I am Buttrazed y the owns, of this property to perform the work for which application Is made and I comply with the <br />Slato tors Law 1 RC and 296,200 WAC. <br />. s <br />_____7o/d <br />Signature of rasp o rectorAul oriza gmr ate 1j <br />Z <br />