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� <br />PE�2MIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9Ei201 <br />425-257-8810 - FAX 425-257-8857 <br />- , ����'�,'�I'� <br />- i_' : _ �_� J �J LS <br />1 AUG 2 4 2004 <br />_ <br />��� nc cvco�7T <br />SITE ADORESS -� .�— PARCEL TAX I.D. # pE47MlT'M�0''P�i�l�r, �Prvir�e <br />�,r � �� z sT. s� a � Z�os�9�3o�qmo ���D� oa7 <br />BLOCK TRACT <br />�ESC. <br />V W IVCI( nV VnwJ � <br />l, ee 6� on 9.�t' � sti o,� 17 �'� Cnr�Is 5/�e� <br />TENANTNAME <br />�10r^��5 I e�i � ��f <br />CONTRACTOR �7- �}crd�- ( <br />PNONE Z�„� �' 7Z. E�� O� �� O <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK � J QO <br />CONTACT FOR PERMIT <br />(��ti�e M�/irl(� <br />ADDRESS (�(OO ( <br />Building ���jjj Mechanical <br />PERMIT B Combination �} Plumbing <br />TYPE DemolitlOn � Sign <br />B Sprinkier <br />PHONE <br />Z�b_,7ZG_ 04�f� <br />/e `r ZIP CONTR. LICENSE K <br />, �' �'!o�' 03 8'15 Z <br />�Atldilion <br />Alteration <br />Naw <br />RepalriMainl. <br />HEATSOURCE <br />D EIeCUic <br />U Gas <br />U Other <br />CITY OF EVERETT LOCAL SALES TAl( COUE IS �105 <br />WORK�ESCRIPTION � C^ r`,S�O� S%�S%?M <br />�'nsT�.11aT�n aF �fL�dO Fi/� �uC'1°��- <br />NO. � TVPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH OASIN) <br />SHOWER <br />KITi.HEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKI�'G fOUNTAIN <br />FLOOR DRAIN <br />� BACKFLOW PREVENTER <br />SINK (SERVICE/BARiMOP!ETC.) <br />_ OTH�R <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HFAT PUMP <br />UNIT HEATERS <br />CLOTHES ORYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACElSTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />.�_ F�re � � ss, � 5ys`T�M <br />I HEREBV CERITIFV THAT I HAVE READ AND EkAh11NED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GUVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL �.AW REGULATING CONSTRUCTION CR THE PERFORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WMICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CO� C�ORY `W 18.27 RC W At�O 200 WAC. �/���� \ <br />Signature of Owned ontractodAulhonzed Agent Date I I.�e <br />v <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />