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DEC-7-2004 08:08 FROM: <br />T0:14252578857 P.1 <br />PERMiT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADORESS <br />LOT N0. <br />j�erri � an�s � <br />TENANTNAME <br />tC.erri j o+�.QS <br />f,uF�S c n� � <br />CONT�t, j10EN�E / _ <br />U9E OF BUILDINO <br />PARCEL TAX I.D. M <br />C S % �DOA(: <br />e�ocK I rnncr <br />w Mvkt (�ro �, <br />ICONTACTFOR <br />(ri nda <br />Vn �u..es <br />• <br />Z � <br />Q�'a!')3 3 3 9-�Z.71 <br />�Th�-►Q��sl �.r ��0 32� <br />t+ �� r� _�I _ f�RESS �`� CFI�� PHONE <br />l_ �.(�/ CAJ q <br />�(� z8� iylvwtd�ta< �-t 4.� $o Co 2�� <br />J � <br />HEAT 90URCE � CONTRACT PRICE OF WORK <br />Electric � Gas _ Other I �tl� — <br />WORK DESCRIPTIO <br />._..f►��(rr� �=►replace �-In�e.rf �/�a.r piP�n� <br />N0. I TYPE OF FIXTURE OR REM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Showar <br />Kitchen sink 8 dfaposal <br />Dishwasher <br />Clotlias washar <br />Laundry tray <br />Sink (servicelbar/mopletc.) <br />Backflow prevenler <br />Urinal <br />Drinkinp Fountain <br />Floor drein <br />_ Grease Vap <br />Roof dralns <br />Othar <br />N0. I TYPE OF FIXTURE OR ITEM <br />AIC - alr handling units <br />Forced afr systems <br />Gas piping <br />Walar haater <br />Gaa fireplace <br />Gaa re�ge <br />Clothes dryer <br />Renge hood <br />Exhausttan <br />Heat pump <br />Unit heater <br />Bofler <br />Refrlgeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 1�05 <br />t hereby ceritily lhat I have read and examined ttils applicatlon and know the seme to be trua and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied wilh whether spec�ed herein or not. The g2ntlnp of a pertnll does not presume <br />ro give authonry W violate or cancel the provision of any other state or local law regWatlng conswctlon or the perfortnance of <br />conslruction. That I am authorized by Ihe owner ot this property to perform the work for which appllcatlon Is mede end I comply with the <br />State Contractors 18.27 RCW and 2 6 200 WAC <br />s '�� �� �- ��o �� <br />__,�__.__.__,.... --�---� �-�- <br />