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P�RMIT APPLICATI�,N <br />CITY dF EVL=RETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-9810 <br />SITE ADDRESS <br />��i3 /�9'� R,a� sr <br />LEGAL L07 NO. � <br />DESC. 'R .--. <br />OWNER <br />Quadrmit Corporation <br />TENANT NAME <br />CONTRACTOR <br />"Samc as Owner" <br />PHONE <br />PROPOSED USE OF BUILDING <br />Singlc �amily Residencc <br />CONTRACT PfiICE OF WORK <br />WORK DESCRIPTION <br />Singlc �amily Residencc <br />NO. I TYPE OF FlXTURE OR I1�M <br />PARCEL TAX I.D. N <br />sS-Ev <br />A�ORESS <br />P.O. I3ox 130; Bellevue, {VA 98009 <br />CONTACT NAME <br />Katrina Toolc <br />ADORESS <br />Building Mechanical <br />PERMIT �•Combination � Plumbing <br />rvPe 'C"]'Demali!ian Sign <br />U Spdnkler <br />WATER :'IOSET <br />BATHTUB <br />I.AVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISPOSAL <br />DISHWASHER <br />IAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DflINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />uINK (SERVICE/BAR/MOP/ETC.) <br />OTHER��0S8�yj� <br />� <br />� <br />w /%�/ �� ' d� <br />PERMIT N <br />� <br />425 62G-8373 <br />425 455-2900 <br />PHONE <br />(425) 6A6-8373 <br />ICONTR. LICENSE R <br />QUMRC*2210� <br />adaitan HEAT SOURCE <br />WORK Alleratbn Electric <br />1 YPE New x� Gas <br />RepairlMatnt O�her <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3f05 <br />N�7<< 7# a! � O <br />N0. � TYPE OF FlXTURE OR ITLM <br />A/C — MiANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FlFiEPLACE/STf�VE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAR FANGE <br />G.+� PIPING <br />EXHAUSTFAN <br />OTHER _. ___ <br />I HEREOY CERITIfV THAT I HAVE RF1�D AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TAUE AND CORHECT. ALL <br />PROVISIONS OF IAWS AND ORIDI!•IACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WiTH WHETHER SPECIFIED HEHEIN OR <br />NOT. THE GRANTING OF A PERIAIT DOES NOT PRESU�AE TO GIVE AUTNORIN TO VIOLATE OR CANCEL THE PROVISION Of ANY OiHER <br />STATE OR LOCAL L1W REGUIhTING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. iHAT I AM AUTHORIZED 0Y T}1E <br />OWNER OF THIS PROPE9TY TO PEFFORM THE WOFK FOF WHICH APPLICAT20N IS MADE AND I COMPLY WITH TME STATE <br />CONTRACTORS LAW 1827 RCW AND 298.200 WAC. <br />/Z�/ C� l7 <br />l <br />