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MHY-3-2004 08:48 FROM: T0:14252578857 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 /> SITE ADDRESS PARCEL TAX I.D.N PERMIT M <br /> 2b3 E 1�i��.�d 2 Do(vo�o�a�aZ.o� Ytit�yGs wl <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PMONE <br /> ca-� I cu.�,-�-�e. Zos ��✓i�ew,e���r� 4��3 �'z.� 3y�Fn��{ <br /> TENANTNAME CONTACI�FOR ERMIT PMONE <br /> � I C�I�G/GCI'�uSflc✓ c9dCo�2�d-�/`1c� <br /> ^pry���r�,, �+ � ADDRESS S ZIP CONTR.LICENSE/ <br /> PHONE " `C � � °�``�� G�,�4�fKJ�d 4�/o,g <br /> �Ln Z�d'�'�IXJ Z��b`/�2°��/41/.F 4J ���Y`l <br /> PROP09E�U5�F�ING I P�E�T 1..1 Sprinklle�`non � Si9 bingel ITMORK R a Ph�TMeln` I HEAT60�UkcR�Cc <br /> g p( <br /> LJ <br /> CONTRACT PRICE OF WORK , n� ' — CITY OF EVERE AL SALES TAX GODE IS b705 <br /> �.r <br /> WORK CESCRIPTION ^�� � �� I. _ /I_ _n r�y; <br /> i S' ��� Ci 4L <br /> � <br /> PLUM8ING MECHANICNL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTUP.E OR ITEM <br /> WATER CLOSET(TOILET) A1C-AMANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER • UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE H000 <br /> LAUNDRY TRF.Y � WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/ST�VE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPL4CE <br /> FLOOR ORAIN GAS RANGE <br /> BACKFLOW PREVEtJTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC,) EXHAUST FAN <br /> OTHER _ _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAA7INED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL <br /> FROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS NPE OF`NORK WILL BE COMPLIED WI7H WHEIiER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES N0T PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 7HAT I�M AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPlICA710N IS MADE AND I COMPLY WITH THE STATE <br /> CONTRA ORS IAW 27 RCW AND 298.200 WAC. <br /> �d�'�—�A�u � �'.�l�.?� �SZ�� <br /> Sign ir�OwnerGontractor���enzetl gent �ate <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />