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. <br /> SEP-22-04 WED 04�57 PH EVERETT PERNIT SERVICES FAX N0. 425 257 A857 P, Ot <br /> .._.. . .. .� — . <br /> � PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR 9TREET, EVERETT, WA 98201 <br /> ` 5-257-8A10-FAX425-257-8857-www.evereriwa.org <br /> APPLICATIONS ARe ACCEPTED FROM B AM TO�PM -pEBIT d�CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADORESS /� PARCEL TAX I.D.i PERMIT N <br /> 53� P(G�tu.c� ��:�.. 003 000o (? 4-Oa' �oyoR-U(,1� <br /> IEGA LOTNO. BLOCK TRqCT <br /> Cc£C. <br /> otiNi " r <br /> �o�� �w�or i� OT .J�+R ORE33 /II MONE <br /> G•� e-f' �,'✓...✓�,-t4- 3l 07 Gol ��",l. Edtref� y32ao 47S'3o3-fq7 <br /> TENANT�� CONTACT FOR PERMIT PMONE <br /> _�/� . I �arc y l�a.Q k,+.r 't7.S- 3�3 - I l I"] <br /> CONTRACTOR � ^ _- J. � , ADDRESS <br /> S-�'��c�tr �ro�sirw CITV2IP PMONE <br /> "" �/72/ Ner-t{�wa��' D�. Citll' <br /> coNra.uceNs�x �T'(�Z�LC. ( 21 oZ v!q qy.4�tG ��'S$o-l23'� <br /> —US[5 OF BIUIL.OINO n I HEAT SOURCE CONTRACT PRICE OF WOR1( <br /> fZ�S i Qt.Du ( p�' `Elecaie `�,Gas_OthQr <br /> WOf:KOESCRIPTION, ,�.Q, Q�d �� ,�� p50.�Gp <br /> � <br /> 'j}�m o � i'f� �� o G� er�.¢1.S!�� L _ � p /�, <br /> SIM+.�-�'tfe S i'�°-!. I'e•�x�t.�R i 0.i 1 A�^+ PR.✓ '+"�c �,wn'�r»u n.i�'7 IQLv�oA.ra� r�Q.�'1 . <br /> Iy PLUMBING MECHANICAL <br /> N0. TYPE•Of FD(TURE OR ITL•M NO. 7YpE OF FIXTURE OR REM <br /> _ Tofl�t _ NC-alr hanElinp units <br /> _ Bathlub _ Forcedairsystems <br /> ._, lav:,tory(�.vo�h 6i:,in) ` Gae pipirg <br /> , Siicwur Wa�er hea!er <br /> ___ ;<i:c^en sinp 3 di.^.;,osnl Gas ireptacs . <br /> __ Dirhv,�shcr _ Gas renye <br /> _ Cl.;thes w:.sl;or _ Clotha dryer <br /> _ L�undry try _ Ranps hood <br /> _ Sink(uervica/barlmop/otc.) ` E����� <br /> ,� Bac►Oowprnvenmr ` Heatpump <br /> __ Urin�l _ Unitheater <br /> _ Orinking Fountain ____ Boil�r <br /> _., Flaar drain _,,,, Rehige2tion <br /> _.._ Greace trep Woodstnve <br /> _,_ Feaf d�eins _ Cthor <br /> Gtr ar <br /> � -' � --•----- ---- — � <br /> f _ � _` CITY OF EVERETT LOCAL SALES SAX COOE IS 3103 <br /> � <br /> } I�erol;y ceri5fy tn,t I hav�n:�d ond examinod this appllcaGon anC kraw the�ame b he We and corceci All prohmon3 of laws and <br /> ord(n�rce povorning this lypq of work will bc complied with whether speotfied herdn or not The prandny of a parmit doas not pretums <br /> to�ive authority W vlolale or cancel the proviabn af arry oNer state or Iopl law reguhtlng eonstruction or the performance of <br /> cr.r��ttucticn.Th:,t I sm�uchoriznd by Ihe owner of this property to perfortn tlMe work for which applica5on Is made�nd I mmpty with Rfe <br /> Sbtn Co nors:aw 1D.27 Rf,W y�d 2�J6.200 WqC, <br /> �(n�n,�t.e�. 6+iH 9�'��-�o'/ <br /> S�r�nau�;e u�6wn.nGoncracto�lAutliorizca Apent ate <br /> SEP-22-2004 16�23 , 425 257 BB57 96: P.BI <br />