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c' PE�MIT APPLICATION <br />F' CITY OF EVERETT PERMlT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425•257-8810 <br />siTe aooaess <br />a,��o i <br />IEGAL LOT NO. <br />oesc. S- • <br />s� <br />OWNER <br />Q44�rG.� / C'/'�a r� �� <br />TENANTNAME ' <br />CONTRACTOR <br />ngamR, aa Oc.�nr.-" <br />PHONE <br />PROPOSED USE OF BUILDINO <br />SFR <br />CONTRACT PRICE OF WORK <br />PARCEL TAX I.D. I <br />�� �a7y-�� -or�-oo <br />�� ��X %�S <br />CONTAC7 NAME <br />Ka-��,w,. <br />ADDRESS <br />� //D �Zz <br />i/l� � 0//O ' 0 0 % <br />PERMIT p <br />C D//� — <br />y.f S <br />PHONE <br />T.cJ /U 7IC � /1JE <br />CONTR. LICENSE N <br />��c�Eazazlb � <br />Building Mechanical Addition HEAT SOUFCE <br />PERMIT �Combinatlon R Plumbing WORK �qlteration j]� ��,y� <br />TYPE Demoiillon � SiAn TYPE New �yGea <br />Sprinkler RepaidMeint. U Other <br />CITY OF EVEREIT LOCAL SALES TAX CODE IS 7105 <br />WORK DESCfiIPT�ON <br />S�kyl� �.+„�y ,Qer�c(e�c� <br />L� 7 .� � �ar Q� ci � LG n-�—• <br />MBI (i MECHI <br />NO. I TVPE OF flIfTURE OR ITEM N0. � <br />1 WATER CLOSET <br />� BATHTUB <br />LAVATORY (WASH BAS�N) <br />SHOWER <br />� KITCHEN SINK 8 OISPOSAL <br />� DISHWASHER <br />� LAUNDRYTRAV <br />� CLOTHES WASHER <br />_ URINAL <br />_ DFINKINC FOUNTAIN <br />FLOOR DFIAIN <br />_ BACKFLOW PREVENLER <br />� SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />i�as� � # z15� <br />TYPE OF fl7fTURE OR I7 EM <br />A/C—A/HANDLINO UNITS <br />f'ORCED AIR SYSTEMS <br />IiEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYEF <br />RANGE HOOD <br />WATER HEATF.R <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFV THAT I HAVE REAO AND E7(AMINED TNIS APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GCVERNING THIS TVPE OF WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NG7. THE GRPN7ING OF A PERMIT DOES NOT PRESUME TO GIVE AUTNOPIiV TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORH fOH WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRAC70RS LAW 1d27 RCW AND 2?6.200 WAC. <br />Ci <br />�rz <br />