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; -�� P�"RMIT APPLICATI�. N <br />����CITY OF EVERETT PERMIT SERVICES <br />3200 CF_DAR STREET, EVERETT, WA 98201, 425-257-8810 <br />c'K 13�)5 <br />SITE ADDRESS PARCEL TAX I.D.# PERMIT� <br />zo i t � sT si:, �:vi:�ti:i�T. wn ex�nx om��oxnnnozzon <br />�.-� � � �1 �: , <br />LFGAL LOT NO. BLOCK TRACT <br />DE <br />OWNER ADDRESS PHONE <br />20 I 13 tiT tili <br />I[LI_IiRTtiIiN, til'UART (425�)47•�9?3 <br />• Ii1'IiR1:TT.11'A 9820R <br />TENAN7NAME CONTACTNAME PHONE <br />rnnua.n ui�� azs sw-3i2a ru� <br />CONTRACTOR ADDRESS CONTR.LICENSE# <br />1AtiT 11'All'.It IIIiAII�.R COAtl'ANl' 1:6111 132NU A\'li KI. PASTIVIIC115:DF <br />(�251H14-3124 RIRI:LAND.'4'A esu3d o2/I6/20o5 <br />PROPOSED USE OF BUILDING Bulldinp M�chanic� WORK Additlon ►i T SOURCE <br />PERMIT Com6ln�lion Plumbinp .� NUntlon El�ctrte <br />TYpE D�molilfon Slpn TYPE N�w aa <br />r R� �IdMalnl Iher <br />CONTRACT PRICE OF WORK 5449.IIU CITY OF EVERETT LOCAL SAIES TAX CODEIS 3105 <br />WORK DESCRIPTION <br />Rcmucc%Rcplacc (i:is \1'alcr I Icalcr <br />p UL MBING MECHANICAL <br />N0. P OF FIXTURE I EM 0 P OF IXTURE R ITEM <br />_______ WATER CLOSET _______ A1C•A/HANDLIN6 UNITS <br />____ BATMTU9 ,_____ FORCED AIR SYSTEMS <br />____ LAVATORY (WASH BASIN) _______ HEAT PUMP <br />____ SHOWER ____ UNIT HEATERS <br />KITCHEN SINK 6 DISPOSAL CLOTHES DRYER <br />__ DISHWASHER __ _ RANGE HOOD <br />____ UIUNDRY TRAY ___�__ WATER HEATER <br />___ CLOTHES WASHER ____ METAL FIREPLACE/STOVE <br />___ URINAL ____ FIREPLACE INSERT <br />__ DRINKING FOUNTAIN ___ OAS FIREPLACE <br />_� FLOOR DRA�N ___ GAS RANGE <br />____ BACKFLOW PREVENTER ___ GAS PIPIN6 <br />___ SINK (SERVICEIBAR/MOPIETC.) ___ EXHAUST FAN <br />_____ OTHER��___ —__ __�_ OTHER________ <br />1 MERFBY C[RTIFV TfiAT I NAVE READ AND EXAMINED THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br />PROVISIUNS OF LAWS AN90RDINANCES GOV[RNING THIS TVPE OF WORK WILL BE COMP�IED WIHT WMETMER SPECiFIED MEREI <br />OR NOT. iME GR/1NTING OF A PERMI� DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTIOV OR TME PERFORMANCE OF CONSTRUCTION. TMAT I AM AUTMORI2ED <br />BY THE OWNER OF TfilS PROPERTY TO PER�ORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STqTE <br />CONTRACTORS LAW 1B.Y7 RCW AND 2�J8.200 WAC. <br />Signaturo of OwnadCantractorlAuthori:ed Agoni �.,.��_��.�,-- D�t� �R/03i2004 <br />W Mi <br />