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� ;- F ,:RMIT APPLICAT( JN <br /> �wi�� CITY OF EVERETT PERMIT SERVICES 1/-/G-- oS <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> �-F���:�r <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 37� I SAIITH r\�'G. [VGRIiI'l'. 11'r\ 95201 0057G001900001 /�/� i��� _ � / <br /> y J> i <br /> LEGAL LOT NO. BLOCK ITRACT <br /> DE <br /> OWNER ADDRESS PHONE <br /> 511RS2NUti'I' <br /> li\'IiRE'I`f GOSPLI. �11SSION . r 1.1?jl'i 1-116� <br /> • G\ I:RI:I��I'. 11'A 1ti2U3 <br /> TENANTNAME CONTACTNAME PHONE <br /> P,\�tIiLA IIIt.L .JZS 514-3t"_'-1 .13; <br /> CONTRACTOR ADQRESS CONTR.LICENSE# <br /> fAS7'\VATI:R IIGr\1'IiR CO��IPANY 12(01 13?ND AVIi NG <br /> I�ASI'N�I ICOi?I)I' <br /> 1'� 81�1-311d ti���<LrANi�, W'A 95034 U?�IU _'UU7 <br /> P--) <br /> PROPOSED USE OF BUILDING Buildinp M�chsniea Additlon HEAT SOURCE <br /> PERMIT Comhlnelion PIum6log W�RK , qlteratlon QElectric <br /> TYpE Damolilion SIBn T1'PE New as <br /> S r r Rs airlMalnl lher <br /> CONTRACT PRICE OP WORK Sdd9A0 CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION �Zi���i��,���t��lacc Gas Natcr I Icatcr <br /> .YLr 6'�Gj �Cr�� J%�,('ii'�.:%/i_✓ <br /> UMBI�, MECHANtCAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR iTEM <br /> ______ WATER CLOSET _______ AIC-A/HANOLING UNITS <br /> _______ BATHTUB _______ FORCED AIR SYSTEMS <br /> ______ LAVATORY (WASH BASIN) _____ HEAT PUMP <br /> _____ SHOWER _____ UNIT HEATERS <br /> _____ KITCHEN SINK 8 DISPOSAL _______ CLOTHES DRYER <br /> ______ DISHWASHER __ _ RANGE HOOD <br /> ______ LAUN�RY TRAY ____�__ WATER HEATER <br /> ____ CLOTHES WASHER _,__ METAL FIREPLACEISTOVE <br /> _�_ URINAL _�__ FIREPLACE INSERT <br /> ___ DRINKING FOUNTAIN _�_ GAS FIREPLACE <br /> ____ FLOOR DRAIN ____ GAS RANGE <br /> ______ BACPCfLOiN PREYEhTER _,_ Gi�S FiPING <br /> ______ SINF.: (SERVICEIBAR/MOP/ETC.) ___ EXHAUST FAN <br /> ----- OTNER�---- --- —_____ OTHER-------------------- <br /> -- ------------------------------ <br /> 1 HEREBY CERTIFY TfiAT I HAVE READ AND E%AMINED THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LI1WS AND ORDINANCES GOVERNING THIS lYPE OF WORK WIIL BE COMPLIED WIH'WHETHER SPECIFIED MEREI <br /> OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR C�NCEI THE PROVISION OF ANY <br /> OTMER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TME PERFORMANCE OF CONSTRUCTIDN.THAT i AM AUTHORIZED <br /> 9Y THE OWNER OF THIS PROPERTY TO PERFORM 7HE WORK FOR WNICH APPLICATION IS MADF AND 1 COMPLY WITM TME STqTE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> Signaturn of OwnedContractor/Authorized Ageni Date <br /> . . _ • . ,- i I1,09,?OOi <br /> UI o;, <br />