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,- F' -'RMI1" APPLICATI .N <br /> c�� CITY OF EVERETT PERMIT SERVICES �_ b_o5 <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> I � c�:�si•� <br /> SITE�DDR�F�S�� � PARCEL TAX I.D.# PERMIT�t <br /> ell �`h'ft-Hr[NV1'Al' tiVA'. GV'P.RIiTI�. N'A 9ti203 OOi0S000012?00 �/j� �� �� <br /> �' <br /> LEGAL LOT NO. BLOCK ITRACT <br /> DESC <br /> OWNER ADDRESS PHONE <br /> GI I \'I'.ItALI'\ \VAl' S�\' . <br /> I)t�. XI II i 1�1'-`)���-a�(la <br /> • I:VP.RI:I'l'. A1'A 98'_03 <br /> TENANTNAME CONTACTNAME PHONE <br /> rnnir_i.�� iu�.t. .r..5 sia-�i�•i .i,: <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> PAtiT \\'A"Il[I2 I II'A�I�I:R C0�1PAK�1' I'_G01 132ND A\'li NG P:1till1'I IClli?I)P <br /> I:IRI:I.AND. IVA 93034 p,;i(i '_�1i17 <br /> � (.12i)tild-3124 <br /> PROPOSED USE OF BUILDING eui�dina Mechan�ca WORK Addition HEAT SOURCE <br /> PERMIT Combinalion ' Plumhlnp - Nturatlon DEle�lric <br /> TypE Dumolition Sign TYPE Nuw as <br /> rl kl r Re alrRvlalnl Iher <br /> CONTRACT PRICE OF WORK G;�19.Op CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION Rcinoc�• Rcplucc I?Icctric \1'atcr Ilca�rr <br /> PLUMBING MECHANICAL <br /> NO. 1YPE OF FIXTURE OR 17EM NO. TYPE OF FIXTURE OR ITEM <br /> _______ WATER CLOSFT ______ AIC-AIHANDLING UNITS <br /> ____ BATHTUB _______ PORCED AIR SYSTEMS <br /> ____ LAVATORY (WASH BASIN) ___,_ HEAT PUMP <br /> ___ SHOWER ___ UN'�f HEATERS <br /> ____ KITCHEN SINK 8 DISPOSAL ____ CLOTHES DRYER <br /> ____ DISHWASHER , _ (L\NGE HOOD <br /> _____ LAUNDRY TRAY ___�__ :N�1TER 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 (SERVIGEIBAR/MOP/ETC.) ___ EXHAUST FAN <br /> _ OTHER------- --- --_ OTHER---------------------- <br /> i �[REBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � PROVISIONS OP LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WIHT WHETHER SPEGfIEO HEREI <br /> OR NOT.THE GRANTING OF A PERMIT DOES N07 PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORM14ANCE OF CONSTRUCTION.THAT 1 AM AUTHORI2ED <br /> Gv THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICFI APPLICATION IS MA�E AND 1 COMPLY WITH THE STATE <br /> COYTRP.CTORS LAW 18.27 RCW AND 296200 WAC. <br /> SignaWre of OwnedContrectorlAuthorizod Agani ,_ ;. "� � Date ��_,��:,,���� <br /> vi v;i <br />