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GCT-6-2034 11:45 FROM: <br />TO:14252'�78857 P.1 <br />PERMIT APPLICATION <br />CITY OF 7VERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />(�t ` fnJ2 .f'� <br />PARCEL TAX I.D. k <br />Lk 5- I �Oy V-63 WO <br />PERMIT # <br />MP �/j T <br />_`�(o2.a <br />LEGAIJ LOTNO. <br />I BLOCK <br />TRACT <br />lq l rY 15 f (ZZ� 4 <oZ.0 l cf7k,,¢ue J-e- e*Zaf- VZf- 33 I;> Zr77 <br />TENANT NAME NTACT FOR PERMIT PHONE <br />PIFU S P, <br />CONTRACTOR LAX �'( JrjWjV ADDRESS ZIP CONTR. LICENSE <br />PHONE <br />PROPOSED USE OF BUILu1NG <br />Building <br />Mechanical <br />Addld )n <br />HEAT COURCE <br />DElectric <br />PERMIT <br />Combination <br />lumbing <br />(WORK <br />Alteratlon <br />H <br />L_�4J / Il �^ . <br />TYPE <br />Demolition <br />H <br />Sign <br />TYPE <br />New <br />asl <br />JL�f'Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK 1000 I — I CITY OF I.VERETT LOCAL SALES TAX CODE IS 5105 <br />WORK DESCRIPTION <br />9CLs �D qq I <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ WATER CLOSET (TOILET) <br />_ BATHTUB <br />_ LAVATORY (WASH BASIN) <br />_ SHOWER <br />_ KITCHEN SINK t. DISPOSAL <br />_ DISHWASHER <br />_ LAUNDRY TRAY <br />_ CLOTHES WASHER <br />URINAL <br />_ DRINKING FOUNTAIN <br />FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOPIETC.) <br />OTHER <br />r— L.`i.,' `� <br />MECHANICAL <br />NO., I TYPE OF FUTURE OR ITEM <br />A/C — AIKANDLING UNITS <br />FORCF,D AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLO74ES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACEISTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY r'ERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISION'; OF L �WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIT(TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TAIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MACE AND I COMPLY WITH THE STATE <br />CON,T G�T/{OgR/S}JL�A �i6�AND 29620�l11� /� / <br />7l widr, lllJJ (/ `l/ qzr 772 3 20 <br />SI atuFe of Ownericontractor/AutnOZed Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />