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• � PERMIT �1PPLICATION <br />VITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />SRE ADDRESS ��'K��- pARCEL TAX I.D. N <br />4503 SE19NuRSrRv�. '��osas8 000r� zool <br />oesc. � 20 1 Bt V-� z <br />OWNER <br />SbffN � P�awt DdYc�c <br />TENANT NAME <br />Z�� <br />CONTRACTOR <br />PHONE <br />Pu9T o� M�Mt� iFE �br{73 <br />ADDRESS <br />�03 SE� Hvl�.Sr �/62CT <br />CONTACTNAME <br />Sv++N �- P�trn <br />ADDRESS <br />PcRMIT 71 <br />,r11/�-0�2 <br />♦�,5�31'�� 8464 <br />PlIONE <br />4ZS� 3�� �8460 <br />CONTR. LICENSE 11 <br />PROPOSED USE OF BUIIDIN(i Building Mechanical Aodition HEAT SOURf E <br />PERMIT Combinetbn BPlumbing WORK Alte�allon Electric <br />�j� � C�[-K �R-E. �' TVPE Demotitian U Sign TYPE �ew � c�aa <br />Sprinkler RepaiqMeint. Other <br />CONTRACT PRICE OF WORK GTY OF EVERETT LOCAL 3ALE3 TAX CppE 13 �105 <br />WORK DESCRIPTION � <br />�P�NG� �.�-a��° ��% <br />1°� C -".�� 2`}0 �t � dl<.c,�c._ <br />NO. � TYPE Of FlXTURE OR ITEM <br />WATEH CLOSET <br />_ BATHTUB <br />_ LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPO�AL <br />�ISHWASHER <br />LAUNQRY TRAY <br />_ CLOTHES WASHER <br />URINAL <br />_ DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENtER <br />_ SINK (SERVICE/8AR/MOP/ETC.) <br />_ OTHER <br />�wca.nnnwnl. <br />N I� N�• I 1�'PE OF FlXTURE OR ITEM N�IQ� <br />_ A/C - A/HANDLING UNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />_ UNIT HEATERS <br />_ CLOTHES DRYER <br />_ RANGEHOOD <br />_ WATER HEATER <br />_ METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />_ GAS FIREPUICE <br />_ GAS RANGE <br />GAS PIPING <br />_ EXHAUSTFAN <br />_ OTHER <br />1 HEREBY CERIT!FY THAT I HAVE fiEAD AND IXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND OHIDINACES GOVFRN�NG THIS TVPE OF WORK WILL BE COMPLIED WRH WHEfNER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESU6IE TO GIVE AUTHORITY TO VIJL4? �: pF CANCEL THE PROVISION Of ANV GTHER <br />STATE OR LOCAL LAb1' REGULATING CONSTRUCTION OR TI1E PERFOqMANCE OF CONSTRUCTION. TMAT I AM AUTHORRED 8Y THE <br />OWNER OF THIS PROPERTV TO PERFORM TFiE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACFORS L4W 18.27 RCW AND 296.200 WAC. <br />� h�i(- tJ 7.00� <br />Date I L <br />/Z <br />