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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 36201 <br /> � 425-257-8810— FAX 425-257-8857—w�vw.everettwa.org <br /> I <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� � p 3..-�� <br /> ISITE ADDRE55 PARCEL TAX I.D.N P My�n <br /> I2809 23RD ST 29052000101800 (/�� �/� ' 00� <br /> LEGAL LOTNO. 6LOCK TRACT <br /> � oEbC. <br /> i OWNER ADDRiS9 CITYIT_IP PNONE <br /> I LYNN MIODDEJONG 2809 23RD ST «�arrr,so:o, 425-252-425G <br /> TENANi NAM1tE CONTACT FOR PERMIT PNONE i <br /> Naida Khan 360-945-2787 � <br /> CONTRACTOR \A/CSCO ADDRESS CITY2IP PHONE <br /> ��� 2800 Thorndyke SEATTLE 206-378-6649 <br /> CON7R.LICENSE#WASHIES971 OB <br /> USE OF BUILDING I NEAT SOURGE CON fRACT PRICE OF WORK <br /> � SFR I �Elednc �Ges_Oiher ( 950.00 <br /> WORK DESCRIPTION <br /> REPLACING A GAS TO GAS 5o GALLON WATER HEATER <br /> PLUMBING MEGHANICAL <br /> NO. TYPE OF FIXTURB OR I7EM NO. TYPE OF FIXTURE OR ITEM � <br /> _. Toilet AIC—air handling uniu <br /> � _ Bathtub Forced air systems <br /> � Lavatory(wash b05in) G0s Piping <br /> � 5nower i Waterheater <br /> _ Kitchen sink&d�sposal '� Gas fireplace <br /> _ Dishwasher Gasrange <br /> _ Glothes washer �' C;lothes tlrye� <br /> _ laundry tray Range hood <br /> I _ Sink(service/barlmoplelc.) _ Exhaust fan <br /> _ BeGallow preveMer hiral pump <br /> Urinal Unit heater <br /> Drinkinp Fountain Boiler <br /> Floor draln Rc�ngcrotion <br /> � Grease trap Woodstove <br /> Roof drains Other <br /> _ Other — <br /> CITY OF EVERETT LOCAL Sn�ES Twc cOue�5 3706 <br /> I hereby centify Ihat I have read and examined this application and know the same to he true and correGt. All proviSionB of laws and <br /> ordinnccC goveming thio type of wadc vrill bc complied with whethcr spccified he2in or not.The yraitling Of d yciuiit Uuas uul piesume <br /> ito grve auttority to violate or cancel the pro�lslon of any other state or local law regulating�ronstruaion or the pertormance of <br /> constn:dion. 7hat I am authorized by the ov+ner of ihis property to pedorm the work for which application is made and I eomply with the <br /> Sfate f.:o tr2ctore La 7827 P.CW and 296.200 WAC. <br /> -�.-�-` < < 3 0� <br /> Siqnature�h nr-r Gontracror/Auihorizetl Oent nate <br />