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Sent 6y: HP LaserJet 3100; 4258249516; Au,-B-Of, ; :19P41, Fzq�= 2 <br /> ;--- PCRM'iT APPLIGATIuf� <br /> ,,,,�,m CITY OF EVERETT PERMIT S�RVICES <br /> ' .._�7'"" 3200 CEDAR 5 i REET, EVERETT. WA 98201, 425-257-8810 <br /> � <br /> �— `�—Ol�'��.� usosoa <br /> ; SITE ADDRESS PARCEL TC.X I.D.# PERh11T# <br /> � i01' KRO'�1:�.R AA/f-:, LiVILkLl�l'. A4'A 982J1 UUq37fi725f��U9U0 r,�� <br /> ����.�;���--c;Y � <br /> LEGAL LOT NO. St,OCK ITRACT <br /> .DE$. <br /> OWNER ADDRESS PHRtJE <br /> c::�f.VLs.ALAN aeo-��o sr s� <br /> - 5�'UIiOAIISH, 14'i�. ^e290 ta�.)?,.1-.Ia'� <br /> 7ENHNT NAME CONTACT NAME — <br /> C,�FhFg. JU1 IF. YAh11:LP. I]iLl. PHQNE <br /> �1�5 RIJ-3124 zl;? <br /> CONTf2ACTOR ADDRESS CONTR.LICENSE# <br /> TAST \1';�TFR HF.A�fL.H CUYIPANY 12601 I�'ND :1�'F Nr <br /> F.4STN'\VH945UC <br /> _ (�32>jRl4.?12.1 ICikKI.AND, R',A 440-.1 ;II:U?;200R <br /> PROPOSED USE OF BUILpING Buil�iny Nachenlcn nac;u � <br /> PGRMIT ComhlnaUon �lumoln WORK HEAT SOIIRCE <br /> 9 Alteratlon �Elect.ic <br /> TYPE Demolilion Slgn TYPE C]ryaW ac <br /> r hl r (�RepalrlMalnl thcr � <br /> GONTF2ACT PRiCC OF WORK yq.�9.pp CITY OF EYERETT LOCAL SA�ES 7AX COOEIS 1105 <br /> WORK DESCRIPTION RcmuveiKtplaee Gas R'ate: I learer <br /> I J <br /> IPL�1MAfNG I��HANICAL -� I <br /> �NO. TYPE OF FIXTURE OR ITEM NO. TYAF OF FIXTURE OR ITEM <br /> WATL"R CLOSET _—�—�q/GA/HANDLING UNI75 <br /> _ ____ BATFITUB FORCE7 Alft SYSTEMS <br /> ______ LAVATORY (WASH BASIN) � HEA7 PUtAP <br /> ______ SHOWER UNIT HtATEftS <br /> �-- <br /> _______ KRGHEN SINK 8 OISPOSAL ___�__ CLOTHES ORYER <br /> ______ �I51{�yASHER RANGE 11000 <br /> ______ LAUNDRY TRAY ! WATER HEA7ER <br /> —_�__ CLOTHES WASHER y ME7AL FIREPLACEiSTOVE <br /> _______ UF2INAL Y FIREPLACE INSERT <br /> ____ DRINKING FOUNTAIN GAS FIREPLACE <br /> ___ FLOOR DRA!N _ GAS F2ANGE <br /> _______ BACKFLOW PREVENTER ^ GAS ?IPING <br /> _____ SINK (SERVICE/BAR/6tOPlE7C.) EXHAUSi' FAN <br /> ----- 07HER----- --- <br /> -------------- ------ OTHER <br /> -------------------------- <br /> I ---- -------------------------- <br /> I HEREBY C[RTIFY TI1A71 MAVE READ ANU EXAMINEO iNIS APUGATI04 PN�HNOW T��E SAME TO OE TRUE AND CORRFCT AL(. <br /> hROVI$IONS OF LAWS Po-�O ORDINANCFS GQVFRNIN(i THIS TVPF OF WG 4K VJIL�BE COMPLIEO WIH7 WHETHER SPEGFIED MEREI� <br /> OR NOT. TNE GRANiWG OF A PERMIT DOLS NOT?FFSUGIG TO GW[AUT'�10RI11'70 VIOLAI'E OR CANCEL THF. PROVISION UF ANY <br /> OiHER STATG OR�OL'AL IAW REGUV�TING CONSTRUCTION OR THE P6FFORMANCE OF CONSTRUCTION.THA71 qM AU'HORIZEO <br /> 0Y TM[OWNER OF 7HI5 PROPERTY TO PER�ORM TME WORK FOR WHIC:1qPPLICATION IS MADE AND 1 CDMPLY W17M THE STATE <br /> CON?RhCTORS LAW 18.27 RCW AN� 296100 WAC. <br /> Signnturc ot Ownur/Contractor/Aulhorizod AgeN . � ' ' . Dato <br /> .. _. . .. ._ , , i)y�Og "t�iql, <br /> ` UI e;l <br />