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, JUN-15-04 TUE 04�05 PM �ETT PERMIT SERVICES FAX N0, 4�5'l 8857 P, 02 <br /> PERMIT APPLICATION <br /> CITY OF EV�RETT pERMIT SERVICES <br /> 3200 CEpAR S7REET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> ; SITE qODRESS pARCEL TAX I.D.N <br /> p�L,� � �v(� CCN W PERMIT;Y <br /> � SGy G7- <br /> LEGAL� L NTO O, BLOCK �qCT <br /> DESC. � E GKO7'G�j <br /> �OWNER � ApDR 95 <br /> ZIP pHONE <br /> l�Pn/; <br /> 7ENANtNAME <br /> CONTACTFORPERMIT <br /> �/y� � �� PHONE <br /> (.n 2 V i I 'J,T/rl/�'S (J^ � �h(��,j.✓ �2�1 <br /> CONTRACTOIQ � YZ S`7�� SY <br /> �Z �/'�Q- �k�s�� Z�p CONTR.LICEN9E N <br /> PHONE r"' A � �o-,s.�99 PoZ <br /> ._ � <br /> PROPOSEO USE OF BUILDING Buildiny MCchanlCal <br /> Addition HEA7SOURCE <br /> PERMIT B COmbi�a�i0� R Piumbing IWORK e Altemtloq <br /> 7YPE U Demolilfon ra gign TYpE U New I � ElecUlc <br /> U Sprinkler �� Gas <br /> \ U RepalNMainL Olhar <br /> GONTRACT PRICE OF WORK CITY OF EyERETT LOCAL SALES TAX CODp IS 3105 <br /> WORK DESCRIPTIO%� S� (�'A `( <br /> /l'� . S1� � -✓ � 3 S� F'f- <br /> � PLUMBING MECHANICAL�`--" <br /> N�� 7YPE OF FIXiURE OR I7EM <br /> N0. TYpE pF FIXTURE OR fTEM <br /> „_ WATER CLOSET(f01LET) ,� A/C-A/�{ANDLING UNITS <br /> ,,,. BATHTUEI <br /> _.` LAVATURY(NIAShi DASIN) � FORCEO AIR SYS7EMS <br /> ,_ SFIOW�R ..._ HEATpUMP <br /> ,_ KITCIifN51N1(&pISPOSqL � UNITHGATERS <br /> �, DISHWASHER � CLO7FIES DRYER <br /> LJ�UNDRYTRAY — RANGEHOOp <br /> _ CLO7HCS WA541ER — WA7ER HE4TER <br /> ,_ URINAL — METAL FIREPLACElSTOVE <br /> __ DkINKING FOUNTl11N � FIREPLl1C�INSERT / <br /> .� FLpOR DfZA�N —, GAS FIREPLACE �3•� <br /> _ BACKFLOW pREVENI'FR — �S�NGE ✓ � <br /> ___ SINK(SEIdVICE/B�FZMOP/C7�,) —._ �PIPING �[� � <br /> _� OTfIGR. , - — � E7(HAUS7FAN - � <br /> "`—'- � OTHER �� <br /> � <br /> l HEREOY Cl`fiI11FY T!U1T'I HAVF F.CAD�N�E](AMIN[D 7HI9 APPLICATION AND ISNOyy THE SAMC TO BE TRUE AND CORRECT. ALL <br /> f'FiOVISIONS OF LAWS AND 0�21�INACES GOVERNING 7HIS 7YPE OF WOFK YlILL OE COMPLIEO WITH VyiIETF{ER SPECIFIED FIEREIN OR <br /> NOT. 7HE GRAN'fING OFn PGRMIT DDES NOT PR�SUME 70 GIVE AU7HORITY TO VIOUIT�OR CANCEL THE PROVISION OF ANY OTHER <br /> S'fA7E oR LOCAI.Ll�W(�EGUUITING CONSTRUCTION OR THE PERFaRMANCE OF CONSTRUCTION. THqT I AM AUTHORI2E�BY 7HE <br /> OWNER OF 7hIIS PI:OPERTY TO PERFORM THE WORK FOR WHICH AppLICATION IS MADE AND I COMPLY WITH THE STA7E <br /> CONTRACTORS LAW , CW AND 28fi200 WAC. <br /> Signature of Owner/C t ctor%Authnneed Ayont <br /> Date ^ / <br /> ____ ,___ DEaIT& CREDIT CARD3 ARE NOT ACCEPTED 1 jf� 1 l� 1/% <br /> —._.�__ _ <br />