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T0:14252578857 P.1 <br /> DEC-27-2004 14:26 FROM: � <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 E AM TO 4 PM - DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT (� � � <br /> I a �� sf' 2 Qo4 3l�aof�o 9/� � �� � <br /> LEG LOTNO. BLOCK iRACT <br /> OESC. <br /> o � p� C�7yZp PMONE <br /> . �• sM•'tf► 44�8 �i`n sr �� ��zo� Y�r z.sy��p9 <br /> TENANT NAME CONTACT FOR PERMIT PXONE <br /> - I L !nd� �Z-S' 7'70 3Z�� <br /> l.0 Y��-1/ �C+ ��y e��—pi�✓� ADDRESS � cmrziP PZDIi �L S�7 <br /> t, � <br /> CON7R.LICEND� ft1 w����I���I� �(� q�l� <br /> W�}S'i-I/E.fQ7/QB vcrlrr� <br /> USE OF BUILOING 7 HEAT SOURCE CONTMCT PRICE OF WORK <br /> S �K _Etectric �Gas_Other `�'�� � <br /> WORKDESCRIPTIO�� t � � � �/_ J. -�Y „ /_ ��QOJ� <br /> � � �,�I�l't,C c�'rr� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7URE OR REM <br /> Toilet _ AIC-air handlinp unils <br /> Bathtub _ Forced air systems <br /> lavatcry(wash basin) Gen plpin9 <br /> Shower � Waterheater <br /> Kilchen sink&dlspasal _ Gas flreplace <br /> Dishwasher _ Gas renge <br /> Clotheswasher _ Clothesdryer <br /> Laundry tray ,_ Ranye hood <br /> Sink(servicelbadmop/etc.) _ E�aust fan <br /> Backflow prevenler _ Heat pump <br /> Urinel _ Unit heater <br /> — Boller <br /> _ Drinking Faunte(n — Ratrigeration <br /> Floordrain — Woodstove <br /> Greasetrap '— Other <br /> Roo(draine —' <br /> Olhcf�— -- <br /> CIT'Y OF EVERETT LOCAL SALES 7AX CODE IS J105 <br /> 1 hereby ceritlfy lhat I have read and axamined Ihis eppllcatlon and know lhe seme to be true and correct. All provisfons of laws and <br /> oralnaces goveming this rype ot work will be complied wllh whether specified herein or noL The grantlng of a pertnit does not presume <br /> t�plve authoriy to violate or cancel the proviston ot any olher state ar Iocai law roguleUng conswcqon or the performanu of <br /> construction.That I am aulhorized by the owner ol this property to peAorm the work for which applicatlon is made end I comply wilh the <br /> State Ca ractors La 827 RCVJ and 296.200 WAC. /��7/`n � <br /> �l�c � � T - � <br /> 5 gn tur o wnerlc.on rector �Agent Dete <br />