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PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 320Q CEDAR �T'REET, EVERETT WA 98201
<br /> 425-2�7-8810- FAX 42Ci-257-�857 - www.evei ettwa.oig
<br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �•- �5 � J
<br /> SITE ADDRF55 PARCEL TA% I.D.M PERMIT N
<br /> :307 107th PI SE I 98208 � � I '�1 / l �:� _: -
<br /> ; 1 C',l�L LOT NO. BLOCK TRACT
<br /> i'[`r -- -
<br /> �---- ADDRE55 QT/21P PMONE
<br /> OVJNER
<br /> Cheryl Boze 307 107th PI SE F�-N�ru e�+1�s 4253155333
<br /> _-- ----- _
<br /> - - - - - - - ;
<br /> � TENMIT NAME i CONTACT FOR PERMIT PHONE ,
<br /> �Jennifer Burgess 206-774-9499 I
<br /> - - — -
<br /> CONTRACTOF 1A/ESCO ADDRESS CITV2IP PHONE
<br /> "° 3909 196 St SW, �>��,�w°°� `'�'°�" soo-39e-a6�3
<br /> roNTR ur_er�sea WASHIES97108 _ I
<br /> --- ----------- --
<br /> -- —
<br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WO
<br /> v0111(11@PC�a� ' �' L '� � _EieCtnr � Gas_.Olher � ,6Q2.3rJ
<br /> ------- ------------- - -- I
<br /> WORn DESCRIPTION '
<br /> RFPLACF GAS WATFR HFl1TER I
<br /> – — ---- li
<br /> ---- -- - PLUMBING
<br /> - —– -- — MECHANICAL
<br /> NO I TVPE OF FIXTURE OR ITEM NO. TVPE OF FIhTURE OR ITEM
<br /> 1 Totlet � � AIC -air hanUling unas
<br /> � Halhtub _ Forced air systems
<br /> I avatory(rrash basin) _ Gas pipmg
<br /> snower i Water heater
<br /> hitchen slnh E disposal _ Gas hreplace
<br /> . . IDishwasher _ Gas ran5e �i
<br /> Clothes washr.r _ Cb�hes dryei
<br /> Ii_aunJry tiay = Range hootl �
<br /> Sinh (service/baUmop/etc � Exhaustfan
<br /> � Backflow preventer _ Heat purnp
<br /> �Jmial _ Unrt hea[er �
<br /> Urinking Fountain _ Botler
<br /> Floor tlrain _ Refngerenon
<br /> Grease trap _ Woodstrr+e
<br /> F+aol tlrains _ Other__ .
<br /> Other —
<br /> � CITV OP EVERETT LOC.1L SALES TAX COOE�S 7105
<br /> iiereby cerrtrty that I have reatl and esamined this applicahon and knowthe same to be true antl correct All prwisions of laws and
<br /> „�dinaces governin� thistypa oi work v.nll he complieA w�th whe[her speahed herein or not The grantmg of a perrrnt tloes not presume
<br /> �� qr�e authnr�tp tn �ini.itP rn rancel the picvision of any other state a local law reguiaUng mnslruction or ihe peRamance ol
<br /> . �..,�.; , , 'e r i .,��• -���_t���ri�c•a I,ry the owner of this property to pertoim the vrork tor wh�ch app!icaUon is made antl I comply wdh�he
<br /> , � . , , • �. .: antl 'S6 �00 WAC
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