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SEP-22-04 AED 04�57 PN <br />EVERETT PERHIT SERVICES <br />FAX N0. 425 257 8A57 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR 9TREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-6857 — www.everettwa.org <br />P. Ol <br />APPLICATION3 ARE ACCEPTED FROM 8 AM TO 4 PM - DEBR d� CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADORESS <br />S o 4,' '1�a�or v� <br />�EGn Lo7No, � BLocK <br />t <br />'}in u.S i�ti1 '%�u,'Nnor � <br />7ENANT Y,vNE <br />./��-fi <br />coNrancTUK <br />PARCEL TAX I.D. S pEftM1T K <br />29 os'o800�0l20o I Dpyo9 <br />TRACT <br />O I � I�VYI�GiO <br />c-t� 3! o'� <br />CONTACT <br />�ar c <br />C�o�bvj �i�l. Edtre}� � <br />;cCc� �si.uc�;oh �oH72/ <br />coNra.ucer+s�x ��-�I��c,r2roZ <br />^US[: OF BUIl.0�N0 ~ <br />��Sf�ypl� (�a.1 <br />WORK OESCRIPTION, <br />�,yr� 0 1 i'� � • 1� <br />S IMR. ��<.te 5 1 "f -!. <br />PERMIT <br />l�tl aR k�•+'- <br />4�S- 3o3-H17 <br />�t�-3�3-1/1 <br />CITV2IP PHONE <br />f�el'fi�wi�{' �r. 64��� � <br />"� �b��38'0-(23`� <br />uJA 9Y.'�� <br />HEATSOURCE <br />� tric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />o'f �i• rn,5ida.Ku, -�'a' Qi� i►� .�. fi Sar�cp �e /�, <br />1^t � � � � �'"' P� ✓ '�'�c C.�'r"+ rrr u ✓l i 'f'� /��'�K r!4►'1 . <br />NO. I TYPC• Of FDCTUf1E OR ITL•M <br />_.--I Bathlub <br />._.. lav�tory (wash G�Sin) <br />._ ji:cwJr <br />-- I<il�'iGil 4inA 3 di5;.o501 <br />_-� Olch,vqshu <br />_� Ci.;the�• w�sh�r <br />L�undry ItLy <br />_ SinK (.ervicalbaNmop/ote.) <br />� Bacr,llow provenmr <br />_ Urinal <br />` Orinking Fountain <br />_„ Flanr drain <br />__. Greace trap <br />_, FcotAr.=.ine. <br />--I Gtrer__,--.-- <br />NO. � 7YPE OF FIl(TURE OR REM <br />NG — alr han0linp unils <br />Foreed air rystems <br />G39 piping <br />Wa:er hea!er <br />Gas 9reptata <br />Gas range <br />Ciothe� dryer <br />Ranps hood <br />E�d+awt fan <br />Heat pump <br />Unit heater <br />Boiler <br />ReMgeretlon <br />Woodstnve <br />Othor <br />CtTY OF EVERETT LOCAL SALES SAX CODE IS ]1pS <br />I heral;y ceriti(y that I h�v� ro�d and examinod Ihis appllwGon and krrow the name b be true and corteet All prauis'ana ot lawt and <br />urdlnc;rce poveming thle �ypn of work Hn11 he complied wlth whethar specifieC hercia or nm. The prentinp ol a parmit doas not presums <br />to pive �uthorily ta vlol�te or cancel the pinviaion of any oNer thte or local law regutetlng consWction or the pertortnance of , <br />u:r�etr�ction. That I;rn ouchorizod by lhe ownerof this property to perfortn the work forwhich appl�ca�ian Is made and I compiy with �hs <br />Slatn Co/+opccors .�w 10.27 RC,W y�d 296.200 WAC, <br />5ir�q3iu;euf <br />6+►H 9/'�z/a'/ <br />SEP-22-200a 16�23 , 425 257 885'7 <br />96 : <br />P.01 <br />