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SEP-04-01 TUE 11�18 A� EVERETT PERMIT SERVICES <br />��.....— .� _ <br />FAX N0, 425 257 8857 P, 02 <br />r -- <br />� PER�I17 APPL.ICATION <br />�;���, C1TY OF EVERETT PERMIT SERVICES <br />I 3200 CEDAR STREET, EVERETT, WA 98201, 425•257-e <br />810 <br />91TE AODRESS pARCEL TAX I.D. M <br />i 7 l, c- �— � � � PERMIT M <br />bESC, <br />OWNERCIU J: <br />NAME <br />ro � �! <br />CONTRACTOR <br />EJ�%-A,-�-I�C <br />PHONErLII LI�i_ <br />�� � ADDqESS <br />�4�3s Nc--��_��+� � doa <br />i � <<r lA!/3 � �Lic) � <br />CONTACTNAMQ <br />�h�� ������ ���� <br />AD�pESS <br />I� IO C)c�K/�u I c_e� �2_ �l . <br />' = U� e—�.c U � 7� c�- <br />��_ 7.i� � <br />CONTFt. I.IQBNSE N <br />PpOPO5E0 USE OF BUILDINC� � � � � ��� � � ��� "�� �— <br />8ullding Mechanfcal j� Addition NEATSOURCE <br />PERMIT � Combinatlon Plumbing WORK j�pltereticn b Eiecfric <br />�/ � riPE Demolition Sign IYPE D New <br />�' J"I U 1,L �(� /� � Sprinklc� D Gas <br />U AappiNMalnt. � OW� <br />CONTqACT PRICE OF WORK ,`� �� ' CITY OF EVERE7T LOCAL SALES TA): CODE IS 3105 <br />�OpK DESCqIp710N — <br />�4_fllou-� (' x��� �r� �i� I� 4�c� f�e� 1c�C i w��`� i� 1����,�> ��,�,� . <br />01� nU(� ��. � ��1;'!�t�-��,r� l� �C� . � . <br />Na- I TYPE OF fIXTUqE OR ITEM <br />`_ WATER CI.OSE7 <br />_ BATHTUD <br />_ IAVATORY (W�SN BASIN) <br />_ SHOWER <br />_ KITCHEN SINK S, DISPOSAL <br />__�, DISHWASHEFl <br />�_ LJ�UNDRY TRAY <br />_ C101'HES WASHEIi <br />_ URINAL <br />,_ DFINKINd FOUNTAIN <br />_.._ FLOOR DfiAIN <br />_ 9ACKFLOW PREVENtER <br />_ SINK�SERVICFJBAWMOP/ET�,j <br />_ OTHEFi.,,._ �_ <br />—I ---�._,._. _-^ <br />NO. I TyPE OP FlX7URE OR REM <br />� a� - � WNDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT.yEATERS <br />CLOTHES DRYER <br />RpNGEH00D <br />WA7ER HEA7ER <br />ME7A� FIREPLACEJSTOVE <br />FIREPLqC� INSERT <br />�AS FIHEPLACE <br />GAS RP.NGE <br />OAS PipINO <br />EXHAUSTFqN <br />OTHER <br />I HFREfiY CF.FlITIFY THAT I I{AYE READ AND EXAMINED THIS APPLICn7�pN M;D KNOW THE SAME TO BE TRUE AND CORREGT, AL� <br />PHOVIS�ONS OF LAWS qND OqIDINACES QOYEFNINp THIS NpE OF WORK WILL BE COMPLIED yyliH WHEfHEq SPECIFIED N4REIN OA <br />NOT. TFIEGRANTWGOFApERMITDOESNOTPFiESUMETOGIVEAUTHORITYTOVIOIATEORCANCELTHEPROVISIONOFANYOTHER <br />S7ATE Ofl LOCAL LAW RE6ULATiNG CONSTRUCTION OR TFIE PERFOpMANC� OF CON57RUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF iH15 PROPEFlTY TO PERFORM THE WORK FOFi WHICN APp�ICATION IS MAOE AND I COMPLY WI7H THE STATE <br />CONTFACTORS LAW 10.27 FlCW AND 276.^.0p Wqp. <br />� "�� L�� , �� <br />DaW ' <br />