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JLL-12-2004 07:19 FROM: <br />T0:14252578857 <br />—\ � <br />PERMIT APP�ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERGTr, WA 98201 <br />A25-257-8810 - FAX 425-257-8857 <br />SITE ADDRE93 I � ( C � <br />(o30'L o��i P <br />LOT NO. � BLOCK <br />��h <br />TRACT <br />e ��oZ o l <br />S�l. �- <br />PARCEL TAX I.D. / <br />o3q2q ao�0o I <br />� DY#� _ 9�3 <br />CONTACT FOR PERMR <br />�,l(Adc``��ICNl�UIf � <br />CONTRACJ 01l J��� Ap DRESS j <br />(�.:GCS�1 lVlyle ^ �VIR1r�L' SQ.VUICQJ� `c� <br />0,,,/ �G <br />PH��i.P �-O�"1�� �-6L.� � -C <br />PROPOSED U9E OF BUILDINO Bulldl g <br />PERMR Combinalbn <br />S � TMpE Demolition <br />S�aa� <br />CONiRACT PRICE OF WORK /„�� � <br />l!/ <br />W ORI( DESCRIPTION <br />P.1 <br />PER��rr• <br />IMG 7-�� <br />LIP <br />�zs3a'I IS4 ( <br />�� <br />�Z's?7o 32Fi <br />zm co�rtie. ucense. <br />X ,J �t45 W�r(-c(tSa7io6 <br />C'lq'S "Tb �aAi' C.rJ�� %L�%�," <br />NO. I �'n'E OF FO(TURE OR ITEM <br />BATMUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />IAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEIBAR/MOP/ETC.) <br />OTHER <br />����� <br />Siyn <br />Bndemon <br />u�«.eon <br />B "� <br />����� <br />HEAT30URCE <br />�Ekdrlc <br />Gp <br />� <br />CiTtl OF EVERETT LOCAL SLLES TAX CODE IS �tOS <br />NO., <br />TYPE OF FU(7URE OR ITEM <br />A/C -A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACEISTOVE <br />F�REpLq(� INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />E�(HAUST F/W <br />OTHER <br />I HEREBY CERI7IFV TF1AT I HAVE REAO AND FJfAMINED TMIS APPLICATION AND KNOW T1�E SAME TO BE TRUE AN� IX7hiFit�� • nu. <br />PROVISIONS OF LAWS AND ORI�INACES GOVERNING THIS TYPE OF WORK W��L BE COMPUED WITH WHETHER SPECIFlED MEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTMORITY T� VIOLATE aR CANCE� TME PROVI910N OF ANY OTMER <br />OWNER OF T�TiclB PROPERTY TO PERFORM TFiE WORK OR WMICM MPL�ICATON �S MADE AND I COMPLV WI7}iATHE g��D BY THE <br />CO TORS LAW 27 RCW AND 286200 WAC. <br />"�. A �. , � , _ � T I,� /.. � <br />DE81T 3 CREDR CARDS ARE N�DT ACCEPTED <br />