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� <br /> P RMIT APPLICATIO�N ; ;�����,�j\,J,� 1 <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ;r'iG1t� '? 6 2004 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITEADDRESS PARCELTAXI.D.# :PERMiT���' EVERETT <br /> [nn:m.a•i plPuhlir. Servico5 <br /> 532q �� ct2c.-,��-�--�/ w`( 003`13�a loo qoo �- g��,Q- <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDR'�.SS ZIP PHONE <br /> 1=,Tz�+��„� , C,�2a� �2� i�-nc-,��c�_c wY r=�c-v�-r i c ,�,JA- 5�2�3 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �-��.�{.— � �aN��`� SI-1,4-W/�1 (�w�`�� 7�6 zZ3 I l ZZ_ <br /> CONTRACI'OR -r��E�T ADORESS �'�3o Oc-G � fi��1ls�L ZIP CONTR.LICENSE# <br /> s�4-11�r� '��!r. S iJ(3<—/�D� 3i�Q <br /> PHONE � ��� L1. <br /> PROPOSEO USE OF BUILDING Building f� Mechanical Addition HEAT SOURCE <br /> PERMIT � �ombination f-� Plumbing WORK Alteration Electnc <br /> TYPE Demolition j�Sign TYPE New � Gas <br /> Sprinkle� RepairlMafni. Other <br /> CONTRACT PRICE OF WORK �p D om . � CITY OP EVERETT LOCAL SAL�S TAX CODE IS 3105 <br /> WORK DESCRIPTION ( <br /> �(�S�1,n -L Uf�`c rb I �c S l C-�� <br /> PLUMBING MECHANI.r.AL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATERCLOSET(TOILET) _ A/C-A/HANDLINGUNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> �:-fOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS R.4NGE <br /> BACKFLOW PR�VENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAA1E TO BE TRUE AND CORRECT. ALL <br /> PROVI510NS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHCRITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE Or CONSTRUCTION. THAT I AM AUTHORIZEO BY THE <br /> OWNER OF TFiIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 290.200 WAC. <br /> � ; 3 .Zz • � 4 <br /> Signatur�of Own Contr ctor/Authonzed Agent Dale � I� <br /> DEBIT & CREDIT CARDS AIZE NOT ACCEPTEO <br />