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DEC-21-2005 08:30 FRDM:PERIIIT 4257756315 T0:14252578857 P.3 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 �2�Z� �D� <br /> SITE ADDRE55 PARCEL TN(I.D.# PERMiT a <br /> T t� � O o 7�0 2c*v iJl�3.� <br /> LEOA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE .�7 (Y <br /> �Li.�'t � �GI-G1 l� d"7 y �� ,d�- �i' �� 9��'�3 Zh�z z�� <br /> CONTACTFORPERMIT PHONE <br /> TENANT�NAME I �� , lZ� n�� p(�S� <br /> �d�� . d� y ` a 7 <br /> GO��Ta� � ('n�+,-f/n 1 �ORESS ZIP CONTR.UCENSE A <br /> U /��I� �ti.l Y/W W/!U,[��fg7�� <br /> PHONE k�' ��Cf��l�Y <br /> . — .J—� <br /> drvi <br /> �� �L 7� Z� � <br /> PROPOSE�USE OF BUILOING Building I�l �1echanical AdEition HEAT SOURCE <br /> I PERMIT CombinaUon H Plumbing WORK �Alteratlon EIecV:� <br /> S� IYPE Demolition V 510n IYPE New Gas <br /> Spdnkler Repaidldaint. �Other <br /> CONTRACT PRICE OF WORK � � CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> r ` (� <br /> WORKDESCRIPTION /]� ��I� � /n /Jl�� <br /> J, ,� ,..�.�r. <br /> PI_UMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A1C—AItiANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEF�TERS <br /> KITCHEN SINK 8 DISPOSAI _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY"fRAY � WATERHEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE i <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING fOUNTAIN _ GAS FIREFLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _, GAS PIPING <br /> SINIC(SERVICE/BARIMOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HERE9Y CERITIFY THAT I HAVE READ AND EXAh11NED THIS APPLICATION AND KNOW THE SAA7E TO BE TRUE ANO CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK 1NILl8E CONPLIED WITH WMETHER SPEdFIED HEREIN OR <br /> NOT. 7HE GRANTING OF A PERMIT DOES NOT PRESUM1�E TO GIVE AUTHORITY TO VIOLATE OR Ci,NCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATIN�CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. T�iA?I AM AUTHORI2E0 8Y THE <br /> OK'NER OF TI115 PROPLRTY TO PERFORAI THE WORI<FOR�V111GN APPLICATION IS AIADE AhD I�Oh1PLY WITH THE STATE <br /> CONT CTORS LA .27 RCW AND 2°6.20 r� Zr a�� I <br /> r/1[L{�a„ l ' - <br /> Si al re of OwnedConVactorlA rized Agenl �a1e I <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />