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; - F :RMIT APPLICATI N <br />,„�,� CITY OF EVERETT PERMIT SERVICES <br />._J-"' 3200 CEDAR STREET, EVEREiT, WA 98201, 425-257-8810 <br />CK2G�l, <br />SITE ADDRESS PARCEL TAX I.D.# PERMIT� <br />:RIO U'1��1-�10R1: AV!:. I:VI�RG7'l�. N�A 98:01 0041130b202800 rn O�(j� �D3 � <br />LEGAL LOT NO. BLOCK (TRACT <br />DE <br />OWNER ADDRESS PHONE <br />rinri�s. �ti�t. 3sio wn�n�oisi: nvi. � z <br />• �vi�:ksr��. wn �xzoi �az � ss-si�a <br />TENANTNAME CO�TACTNAME PHONE <br />rnnai:�.niui.i. azs xw•�i�a.i;; <br />CONTRACTOR ADDRESS CONTR.LICENSEk <br />G1tiT R'ATl:lt IILA"II:R C0�1PANY 12G01 132ND AVI, NI. ; AtiT1NIIC052DF <br />� P_NONE �a'Sisi�-3ia� <br />KIRKLAND.Al'A 9R03d 0?il(-2007 <br />PROPOSED USE OF BUILDING Bulldinp M�chini0a WQRK Addition HEAT SOURCE <br />PERMIT Combinalion Plumbin � Allention �Electric <br />TYPE Damolilion Sipn TYPE Naw as <br />I r Ra elrlMalnl ther <br />CONTRACT PRICE OF WORK Sq.�q,pp CITY OF EVERETT LOCAL SAIES TAl( CODEIS 3105 <br />WORK DESCRIPTION <br />Rcmo��c�Rcpince Gas 1Vnicr I lcatcr <br />PLUMBING MECHANICAL <br />NO TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />_______ WATER CLOSET _______ AIC-A/HANOLING UNITS <br />______ BATHTUB �_____ FORCED AIR SYSTEMS <br />_ ____ LAVATORY (WASM BASIN) ______ HEAT PUMP <br />___ SIIOWER ___ UNIT HEATERS <br />____ KITCHEN SINK 8 DISPOSAL __�__ CLOTHES DRYER <br />____ DISHWASHER __ _ RANGE HOOD <br />____ LAUNORY 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 (SERVICE/BAR/MOPlETC.) ___ EXHAUST FAN <br />----- OTHER�,-- _ OTHER------------------------- <br />1 MEREBY CER7IFY THAT I HAVE READ AND EXAMINED THIS APLICATION AND KNOW THG SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIOMS OF LAWS AND ORDINANCES GOVERNING ThiIS NPE OF WORK WILL BE COMPLIEO WiHT WFIETHER 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 />QTNER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TME PERFORMANCE OF CONSTRUCTION. TFiAT I AM AUTHORIZED <br />BY THE OWNER OF THIS PROPEHTY 70 PERFORM THE WORK FOR WHICH APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1817 RCW �ND 29610D WAC. <br />Signature o( OwnedContractorlAuthorized Ageni : Date ��R �� „��15 <br />UI 0]I <br />