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AUG-11-2004 15:15 FROM: <br />TO:i4252578857 P.1 <br />PERMIT APPL�CATION <br />CITY OF �VERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 4�5-257-8857 <br />SITE ADDRESS `' � � <br />zzs rv��� <br />LEGA LOTNO. � <br />k.a� a�e I rn.or.e <br />S� I D <br />BLOCK TRACT <br />PARCEL TAX I.D. f <br />�U�S�C��6o3c3o <br />225' lM.�l J� <br />PERMIT Y <br />M��loB-o <br />� <br />TENANT NAM£ CONTACT FOR PERMIT PHONE <br />� Q2�ln.tei�'� I Ll ncf c �Z, Jr 7? 0 3 Z� <br />r � T p�� �� ADD ESF� S __ � ZIP CONTR. LICENSE p <br />f. 1 1 l' _ �7./ . <br />PHONE � 1 �A�r � �..� J'N(�"SQ%(CtiB <br />� � 28-� �� �LX��n' ��1 `f 5 �" <br />PR9POSED USE OF BUILDING <br />5�� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPT70N <br />Building <br />PERMI7 B CAm6ination <br />TYPE D Demollllon <br />I, Sprinkler <br />Mechanical <br />Sign <br />�AddiUon HEATSOURCE <br />Alleretlon � Electric <br />New Gaz <br />Repair/Meinl. Other <br />CITY OF EVERETT LOCAL SALES 7Ax cooe �s aius <br />p � `� y' 4I ��-/ i12� <br />G <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DIStiWASHER <br />IAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIv <br />FLOOR DRAIN <br />9ACKFl.OW PREVENTER <br />SINK (S[RVICElBAR/MOP/ETC.) <br />OTHER <br />NO., � TYPE OF FIXT.)RE OR ITEM <br />A/C—AMANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUM? <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACEISTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HcREBY CERITIFY THAT I HAVE READ AND EXAMINED TH�S APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVIGiONS OF IAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUI :; ING CONSTRUCTION OR THE PERFORM/WCE OF CONSTRUCTION. THAT 1 AM AUTHORIZEO BY THE <br />OWNER OF THIS PROPEF�'f TO PERFORM THE WORK FOR WNICH APPLICATION IS MADE AND I COM('LY WITH THE STATE <br />CONiRA ORS lAW � RCW AND 295.200 WAC.x p. /�( �n � <br />�1�..�_ ���.�.r�//.l7\ a� /YY <br />DEBIT 8 CREI)IT CARDS ARE NOT ACCEPTED <br />