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ti.• <br />PERMIT APPLICATION �1-°� �����` <br />CITY OF EVERETT l�ERM1T SERVICE <br />3200 CEDAR STREET, EVERETT, WA 9II201 DEC 2 9 2005 <br />425-257-8810 - FAX 425-257-8857 <br />si i t AODRESS <br />�D� S.E. <br />LEG�1L LOT NO. <br />OESC. <br />7[NANTNAME <br />CONTRqCTOR <br />}4�t-r�t No�.-ca:�vFsr' <br />PHONE 2e� �� -�t� <br />PROPOSED USE OF OUILDING <br />CONTRACT PRICE OF WORK \ <br />i <br />WORK DESCRIPTION <br />�xsTa�.az,c,a <br />PARCEL TAX I,D. # <br />BLOCK TRqCT <br />.................................. <br />�ITY OF EVER <br />CONTACTNAME ' - ' '��' "''� <br />PlIONE <br />1C��srBrr klar�sor•! ?�,�lD23 31oc <br />ADDRESS ZIp CONTR. LICENSE p <br />�2? �� qG,-cu g-���.� Se.n-nt,s, w.n. �8►as <br />Building Mechanicai <br />PERMI7 R Combinalion Plumbing <br />TYPE D Demolilion �ign <br />U Sprinkler <br />��.�atse <br />lWdition <br />WORK Alleretion <br />TYPE ew <br />RepaidMaint. <br />HEATSOURCE <br />D Eletlne <br />u ��� <br />u niti�. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />oF �•i �N-rGR.N �.1.� S W� �..►r�.�ATE4 1�v At.�. S 1 � N S <br />��AT Q.S{�j �l S PR\NT'�. <br />NO. I TYpE OF FIXTURE OR ITEM <br />I WATER CLOSET <br />�ATH7UB <br />IAVATORY (VJASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISH WASHER <br />LAUNDRYTR4Y <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYpE OF FIXTURE OR REM <br />' A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEqTER <br />METAL FIREPLqCE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RqNGE <br />GAS PIPING <br />EXHAUST AN <br />OTHER �WIJ$ <br />I HEREBY CERITIFY?HAT I Hi1VE RF1{D AND EXl�AfINED THIS APpLICATION AND KNOW THE SAME TO O[ TRUE �ND CORRECT. ALL <br />PROVISIONS OF Ll�WS AND ORIDINACES GOVERNING THIS TYpE OF WORK WILL OE COMPLIED WITH VJHETHER SP[CIFIED HEREIN OR <br />NOT. THE GR/1NTING OFl� PERAIIT DOES NOT PRESUh1E TO GIVE AUiHORITY TO VIOUITE OR CANCEL TFiE PROVISIOtJ OF qNY OTHER <br />STATE OR LOCAL I.AW REGUI./1TING CONSTRUCTION OR THE PERfORA1ANC[ OF CONSTRUCTION. Tl1�T I Ah1 AUTHORIZED QY THG <br />OWNER OF THIS PROPERTY TO PERFORM TH[ WORK FOR WHICH APPLICATION IS A1AD[ AND I COt.1PLY WITH THE STATE <br />COy TRACTORS I.AW 7p,p7 �CW AND 296.200 WqC. <br />..!/.. L / 1/ <br />�L <br />