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; -�� P�RMIT APPLICATf(� � <br />CITY O� EVERETT PERMIT SERVICES <br />.._ 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />CK 1629 <br />SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br />9�?3 3 PI. SB. 13VI:Rf:TI�. \1'A 9R20S OOG25400000G00 M�y/0' [.�2�{ <br />' /D -2 <br />LEGAL LOT NO. BLOCK ITRACT <br />DE <br />OWNER ADDRESS PHONE <br />9323 3 PI. SI: <br />JOI INSON. I:GLLLY (d25)R70-0767 <br />• I:VI:RI:I�"I', N'A 9R?OR <br />TENANT NAME CONTACT NAME PHONE <br />PA�91:I.A IIILL d25 xIJ-312d sl3? <br />CONTRACTOR ADDRESS CONTR.LICENSE# <br />PAS"I \\'i\"ITR I IfiA'II:R C0�IPANY 12G01 13?ND AVIi NI�, pqS'I'1VIIC05?UP <br />(q25�g1a-3124 <br />KIRRI.AND.IVA 9R034 02/IG�200.5 <br />PROPOSED USE OF BUILDING Bu��d�np Machamca WORK Addit�on HEAT SOURCE <br />PERMIT Combination ' Plumbing Alleratlon �Electric <br />TypE Demolilion Slgn TMPE Naw as <br />r r R� eirlMalnt ther <br />CONTRACT PRICE OF WORK �3q9,pp CIN OF EVERETT LOCAL SALES T!U( CODEtS 3105 <br />WORK DESCRIPTION �teinovc/Rcplacc Glcc�ric R':ucr I Ica�cr <br />PLUMBING MECHANICAL <br />NO. TYPE OF F�XTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />_______ WATER CLOSET _______ AIC-AIHANDLING UNI'fS <br />____ BATHTUB _______ FORCED AIR SYSTEIAS <br />____ LAVATORY (WASH BASIN) ____�_ HF.AT PUMP <br />___ SHOWER ____ UNIT HEATERS <br />____ KITCHEN SINK 8 DISPQSAL ___�__ CLOTHES DRYER <br />___ DISHWASHER __ _ RANGE HOOD <br />____ LAUNDRY TRAY ___� __ WATER HEATER <br />__ CLOTHES WASHER ____ METAL FIREPLACEISTOVE <br />___ URINAL _,__ FIREPLACE INSERT <br />__ DRINKING FOUNTAIN ___ GAS FIREPLACE <br />_� FlOOR DRAIN _^_ GAS RANGE <br />____ BACKFLOW PREVENTER __ GAS PIPING <br />___ SINK (SERVICEIBAR/MOP/E`C.) ____ EXHAUST FAH <br />_____ OTHER___ ___ ___ OTHER________ <br />I HEREBY CERTIFY THA71 HAVE READ AND EXAMINEO THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WbRK WILL BE COMPLIEO WIHT 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 />OTMER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED <br />BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br />CONTRACTORS LAVJ 19.27 RCW AND 29620U WAC. <br />Signaturc of OwnerlContrector/Authorized Agem ;_ "� � Date ��,t,"��a <br />UI 0/jl <br />