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DEC-1-2004 14:04 FROM: <br />T0:14252578857 p,2 <br />�, <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 AGCEPTED FROM e AM TO 4 PM - DE81T 3 CREDR CARDS ARE NOT ACCEPTED <br />9RE ADDRE39 /1 �O z. �i II slUL <br />L <br />LE LOTNO. BLOCK <br />OESC. <br />IZacl h-c IS�n-, zcea�z <br />TENANTNAME <br />PARCEL TAX I.D. i� <br />ll� S4�q, <br />TRACT <br />� llftdc Ln`��1�-� � <br />P�ERMR/ <br />.J <br />' I �!/1��. �G2u(J'f i-�� 7"A732�� <br />CONTRACTORI. �hty �/i—I'p�—�/v8 ApORElS CRY21P PHONE <br />IN�'RlH G [ / <br />cormt. <br />USE OF BUILDING I ' <br />WORK DESCR� N �/ � <br />c�Yl.ff't � i I Ylt� <br />lt,��-� - bafn <br />NO. � TYPE OF FlXTURE OR ITEM <br />BaMtub <br />Lsvelory (waeh besin) <br />Shower <br />Kitchen aink d disposal <br />Dishwsaher <br />Clothea washer <br />Laundry tray <br />31nk (servlca/bedmop/etc.) <br />Back}IOw proventer <br />Urinal <br />Drinklnp Founlain <br />Floor drein <br />Greaae Vap <br />Roof drains <br />Other <br />ao �o'Z.��-�Cj <br />id°/9g <br />HEAT 90URCE CONTRACT PRICE OF WORK <br />_ E�ectrlc �Ges _ Olher `7�N� r —" <br />�urn l�.7h-� $oi'/-er ancQ GtJ�e.�— <br />w/�' p��riz� <br />NO. � TYPE OF FOCiURE OR ITEM <br />A/C — air hantllinp uNts <br />Forced air systems <br />Ges piping <br />Waler heater <br />Gaa flreplace <br />Oee renge <br />qothes dryer <br />Ranga hood <br />Exhauetfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriperatbn <br />W oodstove <br />Other <br />CITY OF EVFRETT LOCAL SALES SAX CODE IS 9105 <br />I hereCy ceritify that I have read and examine0 this applleatbn and know the same to be Uus and com�ct. All provlsbne af laws and <br />ordinaces goveminp this type of work will be complied with whather sp�clfled hereln or not. The yroMMp of a p�rtNt doea not pnsums <br />lo give authority to violats or cancel the provieion of any other atate or bpl low regulatlng eonstructlon or fh� pNform�na of <br />consWMlon. That I am authorized by the owner of this prop�rty to perfarm ths work for which application is made and I oompy with ths <br />Slate Co tra,-cW_rs Ila�'° �8�.27� RCW and 296.2D0 WAC. / <br />�►VtL(c�?LYYt ,G U/l� ��l /�n � <br />