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P�RMIT APPLICATI�� N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERFTT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N PF,RMI7 a <br /> 11014 19th Ave SE 2805 1900 400 300 Doac�s-c�4 <br /> LEGA LOT NO. BLOCK TRACT <br /> OESC. <br /> OWNER AODHESS ZIP PHONE <br /> Coastal-Serhoe PO Box 5267 Everett, WA 98206 425-252-5400 <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR A�DRESS ZIP CONTR.LICENSE M <br /> Gaffney Construction, Inc. 10511 19th Ave SE Suite C 98208 <br /> PHONE 425-338-2114 Everett, WA GAFFNCI 104K3 <br /> PROPOSED USE OF BUILDING �jQ Bullding � Mechanical Additlon HFJ1T SOURCE <br /> PERMIT ��--5 Combination Plumbing WORK�Alteralion � Electric <br /> TYPE K Demolitlon Sign 7YPE New Gas <br /> Ll Sprinkler Repair/Maint. Other <br /> CONTRACT PqICE OF WORK �D� .�--- CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION . / �� ��F r� <br /> De..,p � AJ�w S� s�•�--at«� C��: I�'�J <�4� � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FU(TURE OR REM N0. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET _ A/C—AlHANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SIiOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> I _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> ! FLOOR DRAW _ GAS RANGE <br /> � BACKFLOW PFEVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/M�7P/ETCJ _ EXHAUST FAN <br /> I _ OTHER � OTHER <br /> I — <br /> � — <br /> � � <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br /> PROVISIONS OF V+WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEF;EIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PHOVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWN OF THIS PROPERTY TO P RFOFM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CON CTORS LAW 1827 W 296. 0 WAC. <br /> / � <br /> a --c� <br /> Si nat re of Owne C actod ent Date <br /> ' 1/L <br />