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,r� P�RMIT APPLICATI� N <br /> � CITY OF EVERETT PERMIT SERVICES <br /> ._ 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> ctiias2 <br /> SITE ADDRESS PARCEL TAX I.D.ik PERMIT# <br /> is�� aoc�:r_rr_t.t.r:a nvr_. evr_an�, wn �szo� ooa3so3ozoi�oo jy1 Oy � � — (. �.J j <br /> LEGAL LOT NO. BLOCK ITRACT <br /> DE <br /> OWNER ADDRESS PHONE <br /> is�z itoch�a�r_�i.riz nvr_ �.�zs�ass-i ias <br /> 13AI:GR.JI'PP fi JOIIN • 8Vf_RGT"1', 1VA 9830I <br /> TENANT NAME CONTACT NAME PHONE <br /> rnnir_�n rin.i. �zs R14-312�1 s�33 <br /> CONTRACTOR ADDRESS CONI'R.LICENSE# <br /> PAS"I' 1t',\'fISR 111:AlliR CO\1PAN1' I'fi01 132ND AVG NG PAS'I'\VIIC0�2DP <br /> IiIRI:I.AND, A1'A 98034 0_!IG2005 <br /> (d25)SLI-31''d <br /> PROP05ED USE OF BUILDING Bui�dinp Machani9a WQRK Addition HOT SOURCE <br /> PERMIT Combinetion Piumhin - Alteratlon Electrie <br /> TypE Demolilion Sign TYPE New as <br /> � Ra sidMaint her <br /> CONTRACT PRICE OF WORK S�1�19.00 CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION �tcmovdRcplacc Gas\Vatcr Ilcatcr <br /> UMBI MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET ______ AIC-AINANDLING UNITS <br /> BATHTUB _______ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) __�_ HEAT PUMP <br /> SHOWER ___ UNIT HEATERS <br /> KITCHEN SINK & DISPOSAL _�__ CLOTHES DRYER <br /> DISHWASHER ___ __ RANGE HOOD <br /> LAUNORY TRAY __�__ WATER HEATER <br /> CLOTHES WASHER ____ METAL FIREPLACEfSTOVE <br /> URINAL _,_ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> � FLOOR DRAIN _`_ GAS RANGE <br /> BACKFLOW PREVENTER _i GAS PIPING <br /> SINK (SERVICFJBAR/MOPIETC.) ___ EXHAUST FAN <br /> ---- ---- 07HER--• -------------- <br /> OTH ER A^_____— --- <br /> I HEREBY CERTIFY TfiAT I HAVE READ AND EXAMINED THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED N'!HT WHETHER SPECIFIED MEREI <br /> OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEO <br /> BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MNDE AND�COMPLY WITH TNE STATE <br /> CON7RACTORS LAW 18.27 RCW ANO 296200 WAC. <br /> Signaturn of OwnedContracrorlAuthorized Agem , - � ::: '� , Date �.,�����OOa <br /> U�o�l <br />