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PE 1MIT APPLICATIO <br />4:7'r CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. N P,91VIT tl <br />2323 6317d St SE I 00544901201300 L 5 2 t[ d <br />LE� LOT NO. BLOCK TRACT <br />Robert Golembiewsld 2323 6317d St: SG 98203 425-353-5979 <br />TENANT NAME I CONTACT NAME PHONE <br />CONTRACTOR ADLRESS <br />F?veretil: 1h1ilders, Tiw 24818 4317d Ave NF <br />PHONE <br />425-353-7161 <br />PROPOSED USE OF BUILDING ISM Building f-1 Mechanical <br />PERMIT I TYPE Demolition Sign <br />IIII J(( Combination FIL-(/( Plumbing <br />� J, Sprinkler <br />zip CONTR. LICENSE. <br />98223 223-0! 07-T 11-rR-301PH <br />Addition <br />WORK Alteration <br />TYPE New <br />RepaeRdain- <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CONTRACT PRICE OF WORK $23,600.00 2li' M(.'— I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />S&I <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET / <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNT N <br />FLOOR DRAIN <br />BACKFLOW EVENTER <br />SINK IS ICE/BAR/MOP/ETC.) <br />OTH <br />— <br />— <br />— <br />— <br />— <br />—GAS <br />_ <br />— <br />X <br />A/C - AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACEISTOVE <br />FIREPLACE INSERT <br />FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER ReCeSSed wall heater <br />= <br />— <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />—_ <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACT SLAW 18.27 R¢�AND 296.200 WAC. <br />, L a- -gt�-y� <br />Signatu o wner/Contr ctorl uthonzed Agent Little Z <br />