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OCT-14-02 MON 01:08 PM ( ERETT PERMIT SERVICES <br />FAX NO,( '5 257 8857 <br />P. 03 <br />PERMIT APPLICATION <br />4Ar,-r CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425.257-8857 <br />SITE ADDRESS <br />Jr SE &0eRE'� t1 Wagj& zi <br />ARCEL TAX I.D. 0 <br />o <br />PERMIT M <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE Zn-7Z2 14jj <br />&)1A KjDDLZ HATHcar>(WI ALA*` 1400 -jw0mq jgoz J&HA& <br />TENANTNAME <br />CONTACT NAME PHONE <br />CCO" YUU /� <br />060 �,�Ic,�I-ro-Cas �c7A_'R-TgtVQ <br />�fit��rl^c <br />CONTRACTOR�rk S W AOD � wv(nb 7z7 ADDRESS ZIP <br />J/ 9p � 71SI�`E000�.r <br />PHt lLI91 �N9O ,¢TiLL� wW g4ID6 <br />PROOPPOOSEE/D USE OF BUILDING <br />Bildij� Mechanical <br />D Atl"io' <br />MEAT SOURCE <br />PERMIT <br />Combination PlumbngWORK <br />Alteration <br />(� Electric <br />HV�' <br />111c-�*j <br />D0nolilion Sign <br />TYPE New <br />jD�j Ga; <br />Sprinkler <br />Repair/Maint. <br />Obior ; <br />I <br />CONTRACT PRICE OF WORK 4570 CITY OF EVERETT LOCAL SALES TAX CODE IS 7t05 <br />1�f"/jQ/ <br />WORK DESCRIPTION I 1 � L "lu uvt` I <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SACKFLOW PREVENTER <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />_ <br />_ <br />_ <br />_ <br />._ <br />SINK (SERVICEIGAR/N'OP/ETC.) <br />OTHER <br />EXHAUST FAN <br />OTHER <br />I HERESY CERITIM1Y THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTI IER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />C1 'ER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />NT TURS W 1 27 CW AND 296.200 WAC. <br />Signature of Cwnor/Conlraclor/Aulnor.zed Agent Date <br />t <br />S <br />