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P�t1RMIT APPLICATION <br /> CITY U : EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425.257-8857 <br /> E ADDRESS PARCEL TAX I.D.M PER�MIT s <br /> f, 71r 7 <br /> LEGE' LOT NO._+ BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ,- <br /> _ ``^, ZIP PHONE <br /> >>M '. '�`551 -A•�y ' • t J ( '� , 1. � <br /> TENANT NAME I CON ACT NAM PHONE <br /> \) ct\\C��T \t r 1ORESS���� ZIPy CO�N�TR�. o ENS,jN <br /> PHONE V �lyl Vvl \ � 1T1 <br /> �'. <br /> PROPOSED USE OF BUILDING Building f"1 M9C'anICaI _Additlon HEAT SOURCE <br /> PERMIT jCombination IP Plumbing WORK Alteration [� Electric <br /> TYPE Demolitlon Sign TYPE New Gas <br /> Sprinkler Repalr/Maint. U Other <br /> CONTRACT PRICE.OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION ew <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI\TURF OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> — DISHWASHER RANGE HOOD <br /> — LAUNDRY TRAY WATER HEATER <br /> — CLOTHES WASHER METAL FIREPLACEISTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN OAS FIREPLACE <br /> — FLOOR DRAIN — GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> QTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS 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 AUTHORITY 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 THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLI'(UpQT(THRVA ���� D <br /> 'RACTORS LAW 18.27 RCW AND 259.200 WAC. L'(�,�11{ lVi [ + <br /> JAU ' . �_ N1 ; <br /> Signature of oyimemmm11 rtAulnTrUetaAgent I DateAUG 0 2 2006 <br /> CITY OF EVERETT <br /> Engineering/Public Services <br />