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I�nn: <br />28/2010 12:41 p518 P.002/002 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />� 3200 CEDAR STREET, EVERETT, �i,4 98201, 425-257-881G <br />425-257-8857 FAX <br />ADDRES8 <br />229991'I.Sl4'.1•VI�.RI��I��I�.\VA 9820 <br />OWNER <br />RUc'I'.RU. MI!NI;ItCn <br />CONTRACTOR <br />I�ASI� N'Al-I�.R III�ATI'N CUMPANY <br />vRCEL TAX I.D.# <br />OUBG94000005pp <br />ADDRESS <br />3?n ��� P� sw <br />WA 4N1U4 <br />Carol Randall <br />ADDRESS <br />12G111 132NU AVI[ NI�. <br />42,,�63G705A tiIItRI.ANII, N'A 98014 <br />.P�(4NE r <br />PROPOSED USE OF BUILDING ew�a�oo 'jRSM <br />PERMIT - Combin�6on 8PI <br />RCSidential �ypE DamollUon g� <br />CONTRACT PRICH OF WORK 5.�qq,n� .� <br />WORK DEBCRIPTION <br />Itcmn��Nltcph�cc �i�u 1Vuicr Ileoter <br />__ WAT[R CLOSET <br />�__ BATH7UB <br />__� LAVATORY (1NASH BASIN) <br />�____ SHOWER <br />__.____ KITCHEN EINK 6 OISP08AL <br />____ DISHWASHER <br />___.__ LAUNDRY TRAY <br />___ CLOTHE9 WASHER <br />, _ _ URINAL <br />_� DRINKING FOUNTAIN <br />___ FLOOR ORAIN <br />_____. BACKFLOW PREVENTER <br />—___ SINK (SERVICE/BAR/MOPIETC.) <br />� <br />477366 <br />I L,� � I - �-'�- I - <br />PHONE <br />�425)44J-7iS.1 <br />PHUNE <br />425-636-7054 <br />CONTR.LICEN: <br />fASllS'N'1194N13C <br />U U(W!201 ? <br />� AT SOUR <br />n ENclrlc <br />as <br />lalnf he� <br />,ES TA7( COOEIS 31 <br />FORCEO AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTH:B �RYER <br />RAN6EHOOD <br />WA7ER HEATER <br />NETAL FIREPUICE/STOVE <br />FIREPLACE INSERT <br />OAS FIREPLACE <br />GASRANOE <br />OAS PIPIN� <br />E%HAU9T fAN <br />07HER_�_________ <br />I HEREBV CERTIFV THAT I HAVE READ ANp EXAMINEO THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORkE�' �. ALL <br />PHOVISIONS OF LAWS AND ORDINANCES GOVERNING TIIIS TYPE OF WORK WIIL BE COMPLIEO WIMT WHETNER SPECIFIFO HEHE <br />OR NU7. THE GRANTING OF A PERMIT DOE6 NOT PRESUME TO ONE AUTMORITY TO VIOI.ATE OR f;ANCEL Th1E PROVISION OF ANY <br />OTMER STATE OR LOC:AL lAW REGULATING CUNS RUCTION OR TME PERFORMANCE OF CON57RUCTION. THAi 1 AM AUTHORIZFD <br />BY THE OWNGR OF THIS PROPERn' TO PERFORM �fME WORK FOR WNICH A�PLICATION IS MADE AND 1 COMPLV WITH THE STATE <br />CONTRACTORS LAW 18.77 RCW AND 786.200 WAC. <br />of OwnerlContnclor/Aulhorl:ed Apant ����sX,�������� D�1• �� �Z8.2010 <br />� <br />u� �ai <br />