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JUIJ-14-2006 14:31 FROII:PERIIIT 4257756315 T0:14252578857 P.1 <br /> t <br /> PERMIT APPLICA�'ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SI7E ADORESS P RCEL TN(I.D.il PERfdii# <br /> 1 3 � yZ.vcl�e� �� l�`�753Z9 tf�lS�oo fnv�v� -o�11 <br /> LEGA LOTNO, BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 ZIP PHONE � <br /> A-r«. w����ro if ��3� ��-���s�� z s-s -�d3, <br /> TENANT�� I CONTA��FOR�PERMIT�iS �7�� S "i!,� <br /> /\�f GC <br /> CONTRACTOR �� (+� �n� qOURESS ZIP CONTR.LICENSEp <br /> w RJ�� �t ' <jr► v I <br /> PHONE �lx, �) �ayiy� �(i.e ,�.,� � C-rff�J'/�i�.1'97icZg <br /> 20�0 �-Bz " '�i=� ��/9 <br /> PROPOSED USE OF BUILDING I Building Mechanical Atlditicn HEAT SOURCE <br /> !� PERMIT R Combinalion �lumhing WORK �Alteration I �Electnc <br /> , , I� ��� TYPE � pemollllon U Slgn riPE New Gas <br /> � Spr�nkler Repalr/Maint. Olher <br /> CONTRAG7 PRICE OF WORK /q r�l � � CITY OF EVERETT IOCAL SALES TA%CD�E IS]105 <br /> ay > V <br /> WORKDESCRIPTION ! ����� <br /> 9 Ccf �cc� �Q��= <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUR[OR I1EM NO.. TYPE OF FI%TURE OR ITEM <br /> _ WATER CLOSET(701LET) A/C-A/HANDLING UNITS <br /> _ DATHTUB FORCEDAIRSVSTEMS <br /> LAVATORY(WASH BASIN) HEP.T PUMP <br /> _ SHOWER UNITHEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASH[R RANGE HOOD <br /> _ LAUNDRY TRAY � WATER HEATER <br /> _ CLOTHES WASII[R METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR OR4iPl GAS fiANGE <br /> _ DACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> _ OTHER OTHER <br /> _ --- I — <br /> I HEREBY CERITIFY THt.T 1 HAVE READ AND E.�Ah41NED THIS APPLICATION AND KNOW THE SAA1E TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF I.AWS AND ORIDINFCES GOVERNING THIS TYPE OF 1'UORK IVILL BE COMPLIED WITH\VHETHER SPECIFIEO HEREIN OR <br /> NOL TNE GRANTING OF A PCKMI f UOES NO f PRESUME TU GIVE AUTMORITY TO�iULATE OR C'�11JCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LA\N REGULATIN(i CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AIA AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOF WHICH AFPLiCATION IS t.7ADE AND I COMPLY 1NITH THE STATE <br /> CON',R CT�LA�.27 RC,�AND 286.2�D�JJ4�. /^/���� <br /> 4 <br /> U ``� O <br /> Si at ro of OwnedContractor/A nzed Agenl Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />