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DEC-17-2010 11:25 AM SNOHOMISH.ENERGY <br />� <br />360 563 9131 <br />PERMIT APPLICATION <br />CITX OF EVERETT PEF�MIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982U1 <br />425�257-8810 — FAX 425-257-8857 — www.evereriwe.org <br />APPLICATIONB ARE ACCEPTED FROM S AM TO 4 PM <br />SITE ADDREO! <br />�l <br />LEOA LOTNO. BLOCK <br />pESC. <br />NMER <br />/fC-L-f.L� <br />TENANTN�ME '1 I <br />Iul1` <br />5 o,�r'tI`t�n..�o <br />CONTR.LICENBE� �.3��� � <br />h���0�'�i'S bQ_ <br />UEE OF BUIL�iNO <br />WORN DESCRIPTION i( �,�,L � I � � <br />.l� %WI-1 <br />N0. I TVP6 O� �IXTURE OR ITEM <br />_ Bethtub <br />_ Lavetory (woih beein) <br />_ &howor <br />„_ Kitchen slnk 8 dl�poaal <br />,_ Diehwaeher <br />_ Clothes wesher <br />_ Wahr heotar <br />_ Slnk (�aNlce/ber/moplelc.) <br />BackOow preventer <br />� Urinel <br />_ Drinking Fountein <br />Floor dreln <br />_ Groeee trep <br />_ Roo}dralne <br />_ Gthar <br />PARClL TAX I,D, N <br />nucr oR ausonneioN <br />CONTACTFOR <br />:e� 1.id p%►��., <br />�Id.. `p � �� <br />HEATlOURCE <br />_ EleetriC _ Gee _ Olher <br />rnun■ <br />/� -/`�-.D <br />PERMIT M <br />F.G2 <br />�vtOkO�[a.�l?—�r`�� 5�3- <br />i <br />CONTRACT PRICE OF WORK <br />� SIoDD• 00 <br />NO. I T/PE OF FI%TURE OR ITEM <br />A/C — alr handllnp unite <br />Forosd air �yetems <br />Gu pipinp <br />W�rorheaNr <br />Oee firopiecs <br />Os� nnpe <br />Clothe� dryer <br />R�npe hood <br />Ezh�u�t fm <br />Hs�t vump <br />Un@ M�Nr <br />B011if <br />Refrip�ntlon <br />WoaJ�tow <br />Other <br />CITY OF EVERETT LOCAL �AL[S TA)I COOE 10 7101 <br />I herety certlfy thet I heve roed end axomined thie epplintlon �nd know tho seme to ba tn�a �nd aortaG. All provleione at lawe ana <br />ordinencea poverninp thb type ol work will be compll�d wlth whethar �peclAed Mnin or nOt. The pnndnp of a partnit tloe� not pretum! <br />to pive authortty �o violate or canal Ma providOn o( any other �bb o� IOG.� lew repul�Lnp wn�trucUon ot ths psr(Ormena of <br />conatruIXion. Thet 1 am uuthorized by lhe ownar af thli propsrty to perform the work for whleh �pplicaGon i� m�Ce and I comply wlth lhe <br />Smte Controdon Low 7B.P7 RC1N enE 298.200 WAC. � � <br />«y <br />