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�ERMIT APPLICAI �ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX a?5-257-8857 <br /> SITE ADDRESS PARCEL i„X I.D.# PE�jd1T# (! <br /> 10530 I�'~ AVE. SE , EY�l2ET`I" 2$05�%00103100 9 Z'�`�O <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. gEE ATf'A HEb <br /> OWNER A�DRESS 21P PHONE <br /> i�ot� a N�A1�zILoU KEt'PL�1� 3�1� 108"� �E�-t" tiE �8208 425�33-j •0325 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �AFn� o,� ow�t� I t�Ev�til SAYI�012 425� 2� •OS<c8 <br /> CONTRACTOR ADDRESS 21P CONTR.LICENSE# <br /> C�AFFr1EY coN�rft��GT1oN losl I I�TM AV8. 56 �,AFFNGL104K3 <br /> PHONE 425• 33S• 2114 cvU� G 98208 <br /> E�!$1eE�"'t' <br /> PROPOSED USE OF BUILDING Buildi�g Mechanical Addition HEAT SOURCE <br /> '�' pc.c��qNGY_ o�l�'E PERMIT �Combination � Plumbing WORK B Alteration �Electric <br /> TYPE Demolition Sign TYPE �C New Gas <br /> 'M'�'-+-�ANGY-f�1+1(� Sprinkler U Repair/Maint. ONer <br /> CONTRACT PRICE OF WORK ��OO� OGb. OO CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION (Jp�-.1GI('l�L1�lON O� '�-ipGj� 'Y[ � -(4.(Q S'�"p�Y �`��-'] G�• �=j"' <br /> '�Utl.blt-l<�t . �tF-lE �t"TEWo}2}G (�,ITE 't'I�N��) �NE'12G A'�i�vBL� �Ei2 <br /> '�L't�-�• �/vl f7' #P.�040C'o-04£) Ct�ASE �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. . TYPE OF FIXTURE OR ITEM <br /> = WATER CLOSET(TOILET) A/C—A/HANDLIN3 UNITS • � <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP O� <br /> SHOWER UNIT HEA7ERS i <br /> KITCHEN SINi(&DISPOSAL CLOTHES DRYER <br /> = DISHWASHER RANGE HOOD � ^ ,. 1 <br /> — LAUNDRYTRAY WATERHEATER IJU•� <br /> CLOTHES WASHER METAL FIRF.PIACE/STOVE <br /> _ URINAL — FIREPLACE INSERT ,�/ <br /> DRINKING FOUNTAIN GAS FIREPLACE �/' <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICEIBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIOINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUfATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> � �(,ert �2 • i 6• 04 <br /> Signature of 0 ner/Contr ized Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED ��� <br />