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SEP-22-04 �IED 04;57 Pfl EVERETT PERtIIT SERVICES FAX N0. 425 257 8A57 P. 01 <br /> .._.. . .. .� ._ _� <br /> ' PERMIT APPLlCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR 97REET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www,averettwa.org <br /> APPLICA710N3 ARE ACCEPTED FROM 9 AM TO�PM - DEBIT 8 CREDIT CARDS ARE NOTACCEPTED <br /> SITfi ADDRESS PARCEI TAX I.D./ PERMIT/ <br /> . 53 `f Pi�a�iuc,� � so3 C�Goo� � �tlo � 1�. o�F� <br /> IEGA 10iN0, BLOCK TRACT <br /> r,�:c. <br /> 011NL �� �^ DRE55 GTYT MONE <br /> ,�,�o V.j I -AU,'�or i� 07 J�+R <br /> G•� a-�' �✓a✓�,-t�- 3l07 Go(� �.til. Lc✓tref� y32o�o 42f-3c3-Iq7 <br /> TENANT�~ CONTACT FOR PERMIT PMONE <br /> _/v�-� I �Jar c y lalaR.k-�•►� 'tzs- 3�3 - / / 17 <br /> CONTRACTOK c L�i I r, � 1ru�to„ ADy 72/ .fOr���� D�. CITY2IP PHONE <br /> �7�T Gtt Sr �� (3RI�M��� O- <br /> CONTfLLICENSEX v ���3$ ��� <br /> STK��cc. � 2l oZ vfA 4Y7.�� <br /> 115L'OF BIJII.DINO I HEAT SOURCE CONTRACT PRICE OF WORI( <br /> f?.�S i�.pt� ( � `Electric'�Gas,_OthQt <br /> WORK DESCRIPTION, <br /> 'jhv,�,01 ik� •ti o'f c.� r-.¢1,S r�w -f'a' o�i d i h �R. fi Sa,�Ga p, <br /> 5 N�t,�-�<.� S i'�-t r't�'+�-� i°�'1 i�n PR,r '}�n{ �rn m u n i T'-� IQL� ��4✓1 . <br /> �� PLUMBING MECHANICAL <br /> NO, TyP[OF FOCTIJRE Oq ITL-M NO. I TYPE OF FIXTURE OR REM <br /> I _ Tollet ~ — AfC-alrhandlinpunits <br /> ������ _ Forcedairrystems <br /> I.av�tory(wa:h h�sin) G3s piping <br /> Shcw�:r Water nes:er � <br /> __ ;<i:���n sinp 3 dis�o,�i Gas ireplaca • <br /> _ Disr,w�slicr _ Gas ranye <br /> -- Cl.;tha:.•wc.xl;or _ CloNea dryer <br /> _, Laundry try _ qan0s hood <br /> _ Sink(nervicalbaNmop/nte.) _ F�duuat fan <br /> ' BacAltowproventor _ He�tpump <br /> � Uriny Unitheater <br /> _ Orink�ng Fountain , Boil�r <br /> _, Floar arain ,_,�, RehlgeraGon <br /> __,_ Greacelrep Woadstove <br /> _-- Fcaf drin=� _ Othor <br /> G:r.zr '— <br /> - —� --�--� — - � <br /> ----� --•'-'--- �----- — — <br /> ) I�crnl;y ceriGfy tnat I haw•r��d and axam Od�b,VERE�LOCAL SnLES SAX COOE IS 3105 <br /> P p n a n d k n o w t h e n a m�b b e w e a n d e o rt e e t A l l p r o v i�i o n a o(l a w f a n d <br /> urdlna�•cs Govorning lhle lypn of woAc w�11 bc complied wilh whether spec.'Tied hercin or not The prentiny of a permit doas nat presume <br /> to pive authority ta violate or cancd t�e proviaion of arry oNer itate or lopl law regul�tlng eonsW ction ar the perfortnance ot , <br /> u;r��Vuction.Th,;t 1 arn authorizod by lhe owner of thfs property te perfortn the work for which applica5on Ia made�nd I mmpiy wilh t�e <br /> Sialo Co ctors:aw 1027 Rf,W�d 2�J6.200 WAC. <br /> �!^�ln�a.Q,�� 6+�►A `1�'�Z�o'� <br /> S��nanueof 6wn.rrContracto�lAuthoriicAApent ace <br /> SEP-22-200a 16�23 , 425 257 8857 96i P.01 <br />