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NOV-18-2004 08:08 FROM: T0:19252578857 P•1 <br /> � <br /> PERMIT APPLI�ATIORI <br /> CITY OF EVERETT PERMIT vERVECES <br /> 3200 GEDAR STREET. 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 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.�.# P MIT# <br /> i o(.�l� � ?''' �e J� � 3 �a � I'� �-!�l " 3� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER � ADD SJ � ^, n Pd� _ 3�� �Q�3 <br /> �GCr(,�, t'Ci'� �'�-t f a(Q1 � �7',` �Uy2,� `_��✓i�`� <br /> TENANTNAME I CONTACTFORPERMff PHONE <br /> sa� <br /> CONTRACTOR��K ���ci��DRESS CRY21P �� � J <br /> CONTR.LICENSE i1���1e�G� /„L� , ��e�YCU _�L��u��c�, �P y7� _ <br /> , � c.r� �d�� 7�e <br /> USE OP BUILDING� ` HEAT SOURCE CONTRACT PRICE OF WORK <br /> SElecVic _Gas_Other <br /> WORK DESCRIPTION /a,�� �l � f C(f -f ����Z '� <br /> V � �„ V <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FUCTURE OR ITEM NO. TYPE OF FUCTURE OR ITEM <br /> Toilet _ aC-airhandlingunits <br /> Bathlu5 _ Forcedairsystems <br /> � Lavatory(wash basin) Gas plping <br /> Shower � Walerheater <br /> Kitchan sink 8 disposal _ Gas fireplace <br /> Dishwasher _, Gas range <br /> Clolhes washer. Clothes dryer <br /> Laundry tray _ Range hood <br /> SInK(5ervicelbarlmop/elc.) _ [uhaust(an <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unft heater <br /> Orinking Fountain _ Boller <br /> Floordrain _ Refrigeretlon <br /> Grease Irap _ Woodslove <br /> Roof drains _ Othe� <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE I9 3'I05 <br /> I hereby cerilf(y that I have read and examined lhis applfcalion and know the same to he true and correct. All provisions ot laws and <br /> ordinaces governing lhis type of work will be complled with whelher specified herein or not.The granting of a permil does not presume <br /> to 8��e authority to violate or cancel lhe provislon of any other stale or lacal law regulatlng conswctlnn or Ihe performance uf <br /> construction.That I am authorized hy the ownar of Ihis property to perfortn the work for which applicatlon is made and I mmply with Ihe <br /> Stale Co actors La 1 7 RCW and 296. WAC• L 1 /� _ /� ����D � _ �.J / <br /> r ...11 � L 0( 'w� <br /> (/N.L(� Date <br /> Sig ure Owned ontractor Au ed Ag <br />