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,t _ PE ZMIT APPLICATIC _ J <br /> � CITY OF EVERETT PERMIT SERViCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> ch�zs� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ,,,i�, ii��c�:eri:i.i.iai ,�vi_. r.vi:izi�r�, �vn �s�oi oo���ia��oo;no �5��.(-V3� <br /> LEGAL LOT NO. BLOCK ITRACT <br /> OES <br /> OWNER ADURESS PHONE <br /> 22p9 ROCI:IiPGI.LGR AVI� �q';�;19-I;G9 <br /> ItA(i(iGN. RAIZIiN <br /> • I'VI�RI�I l'. N4\ 93201 <br /> TENANT NAME CONTACT NAME PHONE <br /> rn�n_i_nim.t. ��; �u-;iza .i:; <br /> CONTRACTQR ADDRESS CONTR.LICENSE# <br /> I :\tiT \1':\'1'I:R IIGAIIr.R CUMPANI' 12G01 132ND AVI.N1. P:\S'I'\\'lICUS'_'DP <br /> I:IRhLAND, AVA 95034 0��1G'2007 <br /> � (.l��)Sld-31�4 <br /> PROPOSED USE QF fiUILDING Buildinp - Meehanica WORK Addition HEAT SOURCE <br /> PERM�T Combinallon PIum6ing � Altuntlon []Electric <br /> TypE Demolilion Sign TYPE New as <br /> S rink r Re alrlMainl �her <br /> CONTRACT PRICE OF WORK $4d9.00 CITY OF EVERETT LOCAL SALES TAl(CODE15 3105 <br /> WORK DESCRIPTION Itcinu�c-Rcplacc Gas 1Vatcr I Ic.rtcr <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. J TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET ______ AlC•A/HANDLING UNITS <br /> BATHTUB _______ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) ____�_ HEAT PUMP <br /> SHOWER __._ UN17 HEATERS <br /> KITCHEN SINK 8 DISPOSAL ___�__ CLOTHES DRYER <br /> DISHWASHER ____ __ RANGE HOOD <br /> LAUNORY Tf2AY __�__ WATER HEATER <br /> LLOTHES WASHER ____ METAL FIREPLACEfSTOVE <br /> URINAL _�,_ FIREPLACE INSERT <br /> DRINKING FOUNTAIN ____ GAS FIREPLACF <br /> FLOOR DRAIN �___ GAS RANGE <br /> BACKFLOW PREVENTER ,__ GAS PIPING <br /> ----- <br /> SINK (SERVICEIBAR/MOPIETC.) ___ EXNAUST FAN <br /> OTHER------------ ---- OTM ------------------------ <br /> I HEREBY CERTIfY TFiAT I HAVE READ AND E%AMINED THIS APLICATI04 AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS�ND ORDINANCES GOVC-RNING THIS TYPE OP�YORK V✓ILL BE COMPUED WIHT WNETHER SPECIFIED HEREI <br /> OR NOT THE GRANTING OF�PERtd1T DOES N ?PRESUME TO GIVE�UTNOR�TY TO VIOLA7E OR CANCEL THE PROVISION OF AN� <br /> OTHER STATE OR LOCAL LA1N REGULATING CONSTRUCTION OR THE PFRFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED <br /> BY THE OWNER OF TI115 PROPERTY TO P[RFOR�1 THE 1NORK FOR WHICH APPLICATION IS M.40E AND I COMPLY WI7H THE STATE <br /> CONTRACTORS L�W 1827 RCW ANU 296.200 WAC. <br /> SignaWre of OwncrlContractorlAulhorizud Ageni . ;.: " _ � Date �a�19;���5 <br /> UI 0:1 <br />