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PB ;MIT APPLICATIOC� -� ����• :��'���n � � <br /> CITY OF �'VERETT PERMIT SERVICFS .� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �r� 1 2 2004 <br /> 425-257-H810- F.4X 425-257-L357 <br /> .•• r�. nr- FVFRETT <br /> SITE ADDRESS � pARCEL TA%I.D.71 �ppq�,ryp�p'I!�'uhhc Servicas <br /> zo9 C2sr'no i2d, c�sr'r.o � G p054g�ooct�vlo( I IC. yo��-oo <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWI:ER ,� ADDRESS # ZIP PMONE <br /> C25rno 54ua/'e F�Sf �{Z5 pon'T;us /}�. A� ?�3 �'�loY <br /> TENANTNAME ,' I CONTACTNAME PHONE <br /> �aa-� enA� De SuGtn� 0.. <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE N <br /> RThfdO� Gldo l2� �f/e S. ,.r�'�Qci"8"QL <br /> PHO,LU�,`7.�6����� se�Y(e� WA . q8'!o8' R <br /> PROPOSED USE OF BUILDINO Bullding Dp Mechenical Addlllon HEAT SOURCE <br /> TYPEIT H SPr nk�leron n H Si9�mbinp �.�,PE � R Palr/Maint. LJ Ot e�� <br /> Ll <br /> CONTRACT PHICE OF WORR � �jOO -�' CITV OF EVERETT LOCAL SALES TA%COOE IS 7105 <br /> WORK DESCRIPTION �$^�-0.�� u L 3�Q F;re S«P�� �`�$/�M $�'S A� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> I _ WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> �� L�VATORY(WASH BASIN) _ HEAT pUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYEFi <br /> � _ DISHWASHER __ FANGE HOOD <br /> � _ LAUNDRY TRAY _ WATER HEATER <br /> � _ CLOTHES WASHER _ METALFIREPIACFJSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> S�NK(SERVICE/BAFUMOP/ETC.) EXHAUST FPN <br /> _ OTHER g OTHER �ire 5°tPP/esSr'sn sYS��`'1 <br /> I HEREBV CERI7IFY THAT I HAVE READ AND EXAM�NEO THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AN�ORIDINACES GOVEPNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING GF A PERM17 DOES NOT PRESUME TO GI\'E AUTHORITY TO VIOLATE OF CANCEL THE PFOVISION OF ANY OTHER <br /> STATE OR LOCAI LAW REGUTATING CONSTFUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 19.2i RCW D 296200 WAC. � <br /> ?11�.�c� p"l`1�� �fl�/uN <br /> Signawre ol OwneUContractor/Authonzed gent ate <br /> �L <br />