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i <br /> P :RMIT APPLICATI.,,N � <br /> �w✓� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 � <br /> cti is�e <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# ' <br /> 21 iU Cf{DAR ST.GVLRGTT.1VA 4R201 pO51G4447017U0 � <br /> M o� oq-o3 � <br /> LEGAL LOT NO. BLOCK TRACT <br /> OWNER ADDRESS PHONE <br /> 11'AGONfiR.11iRR1'S TA�11 ?UO CI:DAR ST <br /> � IiVLRIiTT. N'A 9R:03 14251259-1796 <br /> TENANTNAME CONTACTNAME PHONE <br /> PAM11IiLA IIII.L 425 N14-J124 x133 <br /> CONTRACTOR ADORESS CONTR.LICENSE# <br /> I':1tiT 11'ATl'.R IIGATIR('OMPAN\' IJ6ul U2NI)AVIf NI! I'AtiT��'II('052I)I <br /> �425)RIQ-3124 I:IRKLAND. AVA 9R1114 U2;162Uo5 � <br /> PROPOSED USE OF BUILDING Bulldinp M�eAmlu Additlon H T souRCE , <br /> PERMIT Combindlon Plumbinp WORK . Nt�ratlon I�clric <br /> TYPE D�molillon g�o� IYPE N�w �s <br /> R� drlMalnl Iher <br /> CONTRACT PRICE OF WORK 54Jv.no CITY OF EVERE7T LOCAL SALES TAII CODEIS a105 <br /> WORK DESCRIPTION k�������,��kcplacc(ius Wntcr Ilc:ucr <br /> PLUMBING MECHANICAL <br /> P OF TU I EM OF IXTUR R ITE <br /> ______ WATER CLOSET ___ A/C•A/HANDLINO UNITS <br /> _______ BATHTUB FORCED AIR SYSTEMS <br /> _______ LAVATORY (WASH BASII:) HEAT PUMP <br /> _______ SHOWER __ UNIT MEATERS <br /> _____ KITCHEN SINK d DISPOSAL __ CLOTHES DRYER <br /> ______ DISHWASHER __ � RANGE MOOD <br /> ______ LAUNDRY TRAY __ I WATER NEATER <br /> �__ CL07HES WASHER ^ METAL FIREPLACE/STOVE <br /> ____ URINAL _ FIREPLACE INSERT <br /> _�_ DRINKING fOUNTAIN OAS FIREPLACE <br /> _^_ FLOOR DRAIN _ GAS RANOE <br /> ______ BACKFLOW PREVENTER _ GAS PIPIN6 <br /> ______ SINK (SERVICE/BAR/GIOPIETC.) EXHAUST FAN <br /> --- <br /> ---- OTHER_ --- OTHER----------- --- - <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APLICA710N AND KNOW THE SAME!O BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF�AWS AND OROINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WINT WMETHER SPECIFIED MEREIf. <br /> OR NOT.THE Gi3ANTING OF A PERMIT DOES NOT PRE'UME TO GIVE AUTMORITV TO VIOIATE OR CANCEL TNE PROVISION Of ANY <br /> OTh1ER STATE OR IOCAL LAW REGULATING CONSTRUI'ION OR TME PERFORMANCE OF CONSTRUCTpN.THAT 1 AM AUTMORIZED <br /> BY TME OWNER Of 1HIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATIpN IS MAOE AND I COMPLY WITM THE STATE <br /> CONTRACTORS LAW 18.27 RCW ANO 298.200 WAC. <br /> Slpnatura of OwnedConlractorlAuthoriz�d Ayeni ��� �l;� p��� <br /> 09/2R/2004 <br /> UI Mll � <br />