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Frnm <br />12114�20t1 t1 09 A730 P.002/003 <br />PkRMIT APPLICATION <br />���,�i�,�� CITY OF EVEF2ETT P�h'1VIIT SEF2ViCES <br />_ 3200 CEDAR STREE�f, EVERETT, YJH. 9ti201, 425-257-8810 <br />425-257-8857 FF�X <br />SITE <br />� i� i nc s i sr.. i:vi-.iii: rr. N n�,szox <br />OWNER <br />(�I�MI'h:SAN', ARIti <br />TENANTNAME <br />CONTRACTOR <br />I�AtiI R'A I I�.K IIPA�fI�H t.'1��11'.AKY <br />PH.�E_ 425�36-70iS�i <br />PROPOSED USE OF BU <br />FiF51l�P.Mla� <br />CONTRACT <br />�RCEL TAX I.D.# <br />no�nz��unnnz�on <br />ADDRESS <br />3�71nGs� tii�. <br />LVI!Rf-.�I i. 1VA '18208 <br />—�CONTACT NAME <br />7N� ��i`� c ` �-- <br />ADDRESS <br />I.'��ol I�: tJU AA'I�: NI�. <br />KIRhI.AtJU. N�A �>An{d <br />PERMITI�JCamhln�llon <br />TYPE [JDomolitlan <br />WORK OESCRIPTIDN �temuve'Nrplace lilecvic N'aier Ile:+�er <br />Plumbinp ""^' <br />siQ� TYPE <br />567414 <br />ia-IG�II <br />PERMIT# <br />i I � �- �� �--1 �� <br />PHONE <br />I IUGIGSU-5�1;8 <br />nz� s3�-�a�4 <br />CONTR.UCENSEp <br />PAtiTW'\V1194RIf(' <br />U 1-0412 0 1 2 <br />Aller�tlon <br />N�w <br />SOURCE <br />WATERCLOSET ._____ AIGAIHANPLINGUNI�J <br />BATHTUB .____ _. FURCED AIR SYSTEMS <br />.__ ____ LAVATURY (WASH BASIN) ..___ HEAT PUMP <br />---.- <br />SNOWER ____ _ UNIT HEATERS <br />KITCHEN SINK 8 DISPOSAI .___ CLO7HE9 �RYER <br />DISHWASHER __ _. RANCF HOOD <br />UIUNORYTRAY �_. WATERHEATER <br />----- <br />CLOTHES WASMER ______ METAL FIREPLA:EISTOVE <br />URINAL _ .___.__ FIREPLACE INSERT <br />ORINKING FOUNTAIN _____ _ 6AS FlREPIACE <br />FLOOR DRAIN _._____ GAS RANGE <br />BACKFLOW PREVENTER ___ . GAS PIPING <br />____ SINK (SERVICElBAR/MOP/ETC.) _._____ FXHAUST FAN <br />OTHER—•----------- - --��--- OTHER----..___------_._---... <br />MEHFBV CF.RTif V i11AT I HAVF READ ANO EXAMINED THIS APUCATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br />��HOVISIONS OF LAWS ANU OROINANCFS GUVERNING TNIS TVPE OF WORK WILL BE COMPLIEV WIHT WHETHER 5PECIFIED MEREI� <br />JR NU�. iME (iFNNTING OF A PERMR bOES NOT PRESUIdE TO (11VE AUiHURITV 1U VIOLATE OR CANCFI THE PROVISION OF ANY <br />pTH[R STA7E OR LOCl�L LAW REGULATINGCONSTRUCTIqN ORTHE PERFORMANCE OF CUNSTRUCTION.'iMAi IAMPUTHORIZE�7 <br />BV THE OWN[R OF TI��S PROPERTV TO PLHFORM TME WURK FOR WMICH APPLIL'ATION IS MADF AN� t COMPLY WITH THE STATE <br />CON7RACTORS l AW iB 11 RCW AND 29610C WAC <br />o(OwnndContnctorlAuthorizodAgont I �I'I /�•����/ �d�• i'�19:2011 <br />{ ( � <br />u� v+� <br />