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12/16/2008 09:46 2538503470 HERMANSON SERVICE PAGE 02/05 <br /> PE MIT A,PPLICATI <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 - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESSPARCEL TAX 1.D.* P RMIT# <br /> .7 a .` ' ; DU l0)C>U CSC)2-()(� 0`.5‘2_- f ' • <br /> LEGAL LOT NO. BLOCK TRACT ' <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP (ThPHONE <br /> I. n ' .VIT CI _A , _ , . <br /> , II_ ad. s tt <br /> TENANT NAME CONTACT FOR P,E IT PHONE <br /> I-RDUL'��CL\ODO L� Q. I ---tack \o• ►gyp' 1 ..o.i. <br /> CONTRACTOR v.\ ' �' ,ADDRESS CITY IP PHONE <br /> �r �` ,!(� � �� l7 2( �'-V 'MC °\J ' \LIR 1 / \AA G 7_ <br /> CONTR.LICENSE# `` , Rel rl^ � <br /> USE OP BUILDINGh HEAT SOURCE CONTRACT PRICE OF WORK <br /> R,Il Y AO _// )octric Gas_Other 1p1 C)l„/0 <br /> WORK DESCRIPTiON t.oace. n4tf \f u, � ` O y_......,c <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&disposal ,_,_ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> — <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer 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 3105 <br /> • <br /> I hereby ceritify 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 /> - Itruction.That I am aut orized by the owner of this property to perform the work for which application is made and I comply with the <br /> . Con actors Law 118.2 -CW a - .200 WAC. <br /> N 0 ,.i. iscor \2 )LSI 0? <br /> Signature • •wrier ontractor ., thdri i gen D.te <br />