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SITE ADDRESS <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />EUc,e_�TT <br />TENANTNAME <br />r <br />PERMIT APPLICATIOnI ; �) <br />CITY OF EVERETT PERMIT SERVICE§�1 <br />3200 C[DAR STREET, EVERETT, WA 98201 <br />425-257-8870 — FAX 425-257-8857 <br />BLOCK <br />PARCEL TAX I.D. it <br />OOr7�'js � So03iop <br />TRACT <br />Cocu �+�t • Ca� � <C7 � O ( �Tw, <br />� qy�u ���-� I CONiACT FOR PERMIT <br />T l <br />CONTRACTOR <br />T-� 6��.2T <br />PHONE <br />.�. <br />PROPOSED USE OF BUI4 IN <br />�.� � <br />_ S t�.v.1 � <br />fl� <br />Z�,3o ADDRESS <br />�C I DFN"� f. Al)� , S. <br />s�'r-� ��� � 8�3 4 <br />Bwlding Mechanical <br />PERMI7 Combinatio�lumbing <br />TYPE Demolition ign <br />Sprinkler <br />CONTRAC7 PRICE OF WORK YZS�J ,^- <br />WORK DESCRIPTION <br />�NS �� o� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ vuH i trt c�OSET (TOILET) <br />BATH7UB <br />LAVATORY (WASH Btio��J) <br />SHOWER <br />KITCHEN '31NK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHE:I WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />v��- S� U,.-/ <br />i�(�i�Qvi� �1 <br />i�� <br />NOV 1 8 2004 <br />. <br />�;sv ��F FVERETT <br />� c . <br />PHONE <br />�ZZ 3 ii2z <br />21P CONTR. LICENSE fi <br />r��A��3� 1 �� <br />�tldition I HEAT SOURCE <br />Alteretlon n Elednc <br />eW H Gas <br />Repair/Maint. lJ Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYpE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORC[D AIR SYSTEMS <br />NEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAA4INED THIS APPLICATION AND KNOIN THE SAME TO BE TRUE AND CORRECT. ALL <br />FROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED WITH 1NHETHER SPEGFIED HEREIN OR <br />N07. 7HE GRANTING OF A PERM1IIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 7HAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CON�TORS��W 18.27 RCW AND 296.200 WAC. <br />mzea,vgent Date n , <br />I �/2 <br />DEBIT & CREDI? CARDS ARE NOT ACCEPTED <br />