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FE8-18-2004 09:28 FROM: <br />SITE ADDRESS <br />LOT N0. <br />14252r78857 P.1 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT. WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. A <br />1?aJc.e�l � � Do�l� q �-� 3� <br />—� B�OCK TR„�T <br />OW NER " <br />/Vlonr� C-c�ol-%� 3 i Iz �kQ�l Lor <br />CL()��Y1�7'� C�'1��`Jt"I <br />f�,,�� V <br />PH ic�� _ s„ � /�..._ L <br />GdI�`fr7c•CJ <br />PROPOSED U6E OF BUILDIN4 <br />CONTRAC7 PRIGE OF WORK <br />WORK DESCRIPTION <br />N0. � TYPE OF FIXTURE OR ITEM <br />CONTACT FOR PERMR <br />eav�lc,�.. f�l (� <br />���ADDRESS <br />Oo`f"hurndNk6 �-� C,� <br />Ii Buiidiny Mechcnlc�l <br />PERMIT I] Combination �Iumbing <br />TYPE D DertwliUon LJ Sign <br />U Sprinkler <br />►n C�4.f � q4 S <br />- �low p�e�er <br />� c�a s -� q�r <br />WATER CLOSET (fOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 OISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER• <br />SINK (SERVICElBAR/MOPIETC.) <br />OT ER <br />�O� <br />PERMITN . <br />� ic �to Z^oas <br />r <br />� � • <br />ZIP CONTR. UCENSE M <br />`��149 �ASHrer4 <br />pdryyy� NEATSWNCE <br />WORK � PJteretlon n E�ectrk <br />TYPE New •1� �a <br />ReP�rlMainl. U O� <br />CfTY OF EV ERETT LOGAI. S/LLEa i nn �.wc �� +� �+ <br />f�Ja-�er fl�c�` r-- <br />N0. <br />TYPE OF FUCTURE OR ITEM <br />AIC – AlHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HE<.TERS <br />CLOTHES DRYER <br />RANGE;i00D <br />WAT'cR NcA7ER <br />METAL FIREPIACE/STOVE <br />FIREPLACc INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I MEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAM.E TO PL- TRUE AND CORREG7. AL� <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WIIL BE COA1PLIED VviTH l"JHETHER SPEGFIED MEREIN OR <br />ST�ATE OR LOCAL IIAW REGUTATING ONSTRUCTION OR THE P RFORMANCE OF CONSTFUC ON. TH T' 1 AM AUTHIORI E BV THE ER <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY 1NITH THE STATE <br />CONTRACT RS lAW 78-27�cW AND 296.200 WAC. 2/( `,/ / <br />� <br />/n . � ��lil/l�n � A \ l� � �/ <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />