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;- P"RMIT APPLICATI _ N <br /> CITY OF EVERETT PERMIT SERVICES <br /> •._ 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> c�;zzis <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �-ll(i I Dli VV. I�VBItl3��l�. 1VA 98?U3 0081GG00001300 , � � � <br /> � ���i e_���1—C'C�� <br /> LEGAL LOT NO. BIOCK ITRACT — <br /> DE <br /> OWNER ADDRESS PHONE <br /> Sd 16 I DR 11' <br /> fI:RGUSON, f3GCKY.0 VINCENI' (425)710-75'_7 <br /> • I:\ Llilc'I'l'. \1',1 9R203 <br /> TENANTNAME CONTACTNAME PHONE <br /> PA�1[LA IIILL d25 Sld-312J sl3> <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> P,\ti I' \V,V I:It III:A"I'I:R CO�IPANY I?C01 132ND AVG NI? <br /> PAST\I'IICOSIDP <br /> (4'_5)R14-±12d KIRI�LAND. 11'A 9803d 02%Ifii'_007 <br /> PROPOSED USE OF BUILDING Buildinp - Machanica Addition HEAT SOURCE <br /> PERMIT Combination Plumbing WORK , N�aratlon QEleclric <br /> TYPE Damolition Sipn T�'PE Naw as <br /> � Re alrlMalnt tl�cr <br /> CONTRACT PRICE OF WORK �qq9.pp CITY OF EVERETT LOCAL SALES TAl(CODEIS 3105 <br /> WORK DESCRIPTION <br /> Rcmo��c.'Rcplacc Gas\1'atcr I lcatcr <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET __ ___ A/C-AIHANDUNG UNITS <br /> _______ BATHTUB FORCED AIR SYSTEMS <br /> ------ <br /> _______ VATORY (WASH BASIN) HEAT PUMP <br /> ____�_ SHOWER � JNIT HEATERS <br /> --- <br /> KITCHEN SINK & DISPOSAL ______ CLOTHES DRYER <br /> ______ DISHWASHER RANGE HOOD <br /> _______ LAUNDRY TRAY I WATER HEqTER <br /> _____ CLOTHES WASHER METAL FIREPLACElSTOVE <br /> _____ URINAL FIREPLACE INSERT <br /> ______ DRINKING FOUNTAIN GAS FIREPLACE <br /> ______ FLOOR DRAIN � GAS RANGE <br /> _____ BACKFLOW PREVENTER � GAS PIPING <br /> ______ SINK (SERVICEJBAR/MOP/ETC.) i EXHAUST FAN <br /> --- <br /> ----- OTHER------ -- --- OTHER---------------- <br /> 1 HEREBY CERTIFY THqT I HAVE READ AND EXAMINED THIS APLICATION AND KNpW THE SAME TO BE 7RUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES I�OVERNING 7HIS TYPE OF WORK WILL BE COMPLIEU WIHT WHETHER SPECIFIED HEREI <br /> OR NOT. THE GRANTING OF�pERM1T DOES NOT PRESU�dE TO GIVE AUTHORITY TO VIOLATE OR CANCE�THE PROVISION OF ANY , <br /> OTHER STATE OR IOCAL LAW REGULl1TING CONSTRUCTION OR TNE PERFORMP.NCE OF CONSTRUC710N.THAT 1 AM AUTHORIZED <br /> BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICHAPPLICAi70N IS MADE AND I COMPLY WITH THE STATE <br /> CO4TRACTORS L�W �8.27 RCW AND 296.200 WAC. <br /> Signatcre of OwnedContracrorlAuthorized Agen� _ Date <br /> . . _ ._ . . , Od D� "'L0; <br /> R4 0„ <br />