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04/14/2004 01:55 42567355080 RUSSELL SIGN C7y PAGE 01/01 <br /> " � L <br /> PERMIT APPLICATlON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 92201 <br /> 425-257-8810—FAX 425-257-8857 � � ( Q�f—b�� I <br /> `f ! <br /> SITEADDRESS PARCELTA'...•. PERMi7�Yo `O� � I <br /> D ZO �/�f0 <br /> LEGAL LOTNO. BLOCK TRACT <br /> UESC. <br /> OWNEjR' ADDRE53 ZIP PHONE <br /> �0�"!� S�/`��� <br /> TE ANT NAME CONfACT FOR PER PHONE <br /> �'z P�i�'R�� � �y �A,�,�'r �. <br /> � en ta��rz�ss�rc �/Z s- 70/0 <br /> CONTRACTOR ��JS$�(� ��r(�L1Q ADDRESSS(�ZC� ZG�TIs�ST3�11P COHTR.LICENSE/ <br /> PHONE <br /> 513-7as-�oro sr�s�. �y��,uWa�c3 ��g p� K��SGoeoqF- <br /> PROP09EDUSEOFBUILDldG I Bullding � Mechanical Additbn I HEATSOURCE <br /> PERx�i B Combfnatbn Pfumbing WORK � aneration ❑ Eledric <br /> TYPE Q DemoliUon Sign rrPe New Ll �as <br /> U Sprinkler RapaidMaint. U OM�ar <br /> CONTRACT PRICE OF WORK qQ � � � CRY OF EVERETT LOCAL SALESTAX CODE 151105 <br /> WORKDESCRIPTION 2f/�tc �(��/�JD. Td I�Sy� � Z�"� IO / <br /> /LL�.7i.�ff7Ep--5/tirFC� �i3�� S/4jy �- Cf��XI? �o w/�GC <br /> Sc��stC�— U L g��� i <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR REM NO. TYPE OF FU(TURE OR ITEM <br /> WATER CLOSET A/C—AlHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER _ Fil�NGE HOOD <br /> LAUNDRYTRAY WATER NEATER <br /> CLOTHES WASHER METAL FIR[PLACE/STOVE <br /> URINAL FIREPLACe INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE � <br /> FLOOR DRAIN _ GAS RANGE i <br /> BACKFLOW PREVEN7ER _ GAS PIP�hG <br /> SINK(SERVICEIBAR/MOP/ETC.) _ EXHAUSTFlJJ � <br /> OTHER OTHER <br /> I HEREBY CERRIFYTHAT I HAVE READ AND EXAMINED THISAPPLICATION ANO KNOW THE SM1E TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED LMTH WHETHER SPECIFIED HERFJN OR <br /> NOT. THEGRANTINGOFAPERMRDOESNOTPRESUAIETOGIVEAUTHORINTOVIOLATEORCANf.ELTHEPROVI510NOFANVOTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZ[D BY TNE <br /> OWNER OF Til9 PROP[RTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COAIPLY WITH THE STATE <br /> CONiW�CTOR�18.27 RCW 296200 WAI� , LY �,�r <br /> �l�.//, ��l '/�}' -� L'-z'/•l�{�`Y <br /> Signat e o erl ont2 / u etl Agant Date I Z i <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />