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,- F-RMIT APPL.ICATI N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />CK 1808 <br />SITE ADDRESS <br />PARCEL TAX I.D.S <br />PERMIT# <br />6P) H 101 PL SI'., FVI(RFTI, WA 98208 <br />008S6861900?0O <br />y� <br />LEGAL <br />LOT NO. <br />BLOCK TP.ACT <br />OWNER <br />ADDRESS <br />PHONE <br />619 H 101 PI, SE <br />HRAN I I I Y, JOlIN <br />• EVERI[ 11. WA 98208 <br />2 <br />(4_.t )_8(1-5335 <br />TENANT NAME <br />CONTACT NAME <br />PHONE <br />UIIPLP.X'IY)WNIIOMli IN M11.1.14RUOK <br />I'AMI-LA 1111.1, <br />425 914.3124 s133 <br />CONTRACTOR <br />ADDRESS <br />CONTR.LICENSES <br />I Ati I N A I I.It lll[A'11!R ('GMPANY <br />12601 132ND AVI? NI: <br />PAtiI W'il('U521)I <br />PHONE 1425)R14-7124 <br />Kil(KI.AN1), WA 98034 <br />_ <br />02/162005 <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Buudinp Mechemce <br />- <br />WORK <br />Addition <br />HUT SOURCE <br />Combination Plumbing <br />Alteration <br />lactric <br />TYPE <br />_ <br />Demolition Sign <br />TYPE <br />New <br />as <br />r r <br />Re a1rlMalnt <br />Mar <br />CONTRACT PRICE OF WORK %449.00 <br />CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br />WORK DESCRIPTION Renuwe'Replace Gas Water Hemet <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO, TYPE OF FIXTURE OR ITEM <br />_______ <br />WATER CLOSET <br />------- <br />A/C-A7HANDLING UNITS <br />_______ <br />BATHTUB <br />—----- <br />FORCED A!R SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />---_ <br />UNIT HEATERS <br />KITCHEN SINK A DISPOSAL <br />—_—__ <br />CLOTHES DRYER <br />OISHWASHER <br />__ _ _ <br />RANGE HOOD <br />_______ <br />LAUNDRY TRAY <br />--I <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIRE PLACEIS TOVE <br />URINAL <br />--__ <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />----__ <br />GAS PIPING <br />SINK (SERVICE/BAR/MOP/ETC.) <br />—__ <br />EXHAUST FAN <br />----- <br />OTHER---------- - --- <br />— -- <br />OTHER---------------- <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WIHT WHETHER SPECIFIED HEREI <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED <br />BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296 200 WAC <br />Signature of OwnerlCdntracto,lAuthori:ed Agen, .�< <� '� / Date 12'07 2004 <br />