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SEP-22-04 AED 04�57 Pt1 EVERETT PERMIT SERVICES FAX N0. 425 257 8857 P. O1 <br /> .._.. . .. .� _ I <br /> ' PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR 9TREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www,everettwa.org <br /> APPLICATIONS ARe ACCEPTED FROM 8 AM TO 4 PM - DEBIT�CREDIT CARDS ARE NOT ACCEPTED <br /> SIiE ADORESS /- y� PARCEL TAX I.D.i pERM1T Y <br /> _... 5 s' ��IG�tta-GK. Pc�,�l,._h o03 G�000D `f 9az Do�10 -oi <br /> IEGA LOTNO, BLOCK TRACT <br /> Ge�C. <br /> OZ'IJL � ) (� TY/tl HONE <br /> �p��� .AW�nori't'� OT �+R RESS <br /> G' a�' F�'✓s,✓t-iE 3f o7 Gol� �14�1. Edtre.fF y3zar 42s- 3o3-l�I7 <br /> TENAN'f4 E � CONTACTfORPERMIT PMONE <br /> _/v/-�4 , I �Jarc y U�IaR.le,� �f'�� 3�3 - i l I� <br /> CONTRACTOR � 1 ADORESS 1 CITY2IP PNONE <br /> �✓��r CohS►rw��o� H72/ !�a'�„''t�T ��. �.R��y�y� O� tj <br /> COkTIL LICENSE p (1 ���s$ ('Z'3 ` <br /> �-1-'K Z�c(, f 2 !oZ u,�A 9Y�t.G <br /> �USI'OF BUIlAINO � ( HFJ1T SOURCE CONTRpCT ppICE OF WORK <br /> ��S i G�y.D� ( � _Electrie �Gas_Other <br /> WDl:K OESCRIP710N �+ 1 , <br /> '�,vr�o � i F� e� O"T U� N.2.S 1�c c. "�'�' Qi d �h �� p S0.✓Go <br /> 5 u►.e,l-�'<,f S i�-e. r'e.�.�e.cQ f��'w r, P,�,r -}L.t C,a»�v,�,u r��f-� IQiv�u� P(4,n . <br /> � PLUMBING MECHANICAL <br /> N0. TYPG OF FIXNRE OF ITEM NO. TYPE OF FUCTURE OR REM � <br /> _ Tollet � A/C-alrhandlinpunits <br /> - ������ _ Foreed air rystems <br /> ,_ lacalory(wash 6isin) Gae piping <br /> ,--- SNcwur Water hea:er � <br /> ___ tGlcwn�ink 3 dixposal Gas ireplaca . <br /> Oi:.hv,�slicr _ Gas renge <br /> _ C�:,thes w«sh�r _, Clothr�dryer <br /> _ Laundry try i, Ranpe hooG <br /> _ Sink(servicolhadmop/ote.) _ E�diawt hn <br /> ^ BacAllowprnvenfcr _ Heitpump <br /> -- �"^y _ Unit heater <br /> _ Orinking Fountain _, Boiler <br /> _, Flanr Crain � Ref�lgeration <br /> __,_ Greace trep Woadstave <br /> _,_ Fcof Ar?ins Othor <br /> G:ner — � <br /> iI —"_.__' — - ' <br /> --•--� --•------ ---•--- — - <br /> � _ � _� C(7Y OF EVERETT LOCAL SALES JAX COOE 19]105 <br /> I hen�i;y ceriGfy that I hava n:�d ond e�minud tl�is appllcation anG kmw y�e eame to be We and rnrceet All provbiona of laws and <br /> ord;n��ce Govorning this typn of work will hc compGed with whet�er:pecified hercin or not TT�e O�ntinp of a permit doas rot preeume <br /> !��i�c iuthority m vlolalu or cancel the proviaion nf arry oNer state or loql law rey�;ytlng eonstruct;on or the perfortnance of , <br /> cr.r�str�cticn.Th.:,t I;m ouchor�zcd by Ihe awner of this properry to perform the work for which applica�on Is made and I�mply with�he <br /> Sia10 Ca nors;.aw 1a27 R,W and 296.200 WAC. <br /> �G�a,Q,�t.e�. 6+►q 9��z�o� <br /> S��n+w;e u�6wn.r�CantractoqAuthanzetl Apent Date <br /> SEP-22-2004 16�23 , 4?S 257 BB57 96: P.01 <br />