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„- F �RMIT APPLICATI�.N <br />CITY OF EVERETT PERMIT SERVICES <br />._"�”' 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />c �:i�sx <br />SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br />I'u ?a ti��� tiV�'. I�A'I;ItI�TI'. �1'A 9ri2u1 un7��?.7ununn3un 1'Y1���I C; (� l' i(� � <br />OWNER <br />�I'I I I\�,1\. �I�IiPStiA <br />C <br />CONTRACTOR <br />f,AS f At':�"II�K I II?ATI:R ('O�II',�A1' <br />P_kiONE �.�'-`�`�•�-�I�.t <br />PROPOSED USE OF BUILDIN <br />ADDRESS <br />iZn�Sti� st <br />• I'A�I'kl'.�I I. A1':1 'l,L'U7 <br />CONTACT NAME <br />I':1�ihI.,11IILl. <br />ADDRESS <br />iz��ui i ��xn n��u �! <br />I:IIttiLANI), \1',1 '+�U} 1 <br />P[RMIT <br />Demolilion <br />CONTRACT PR�CE OF WORK c.1.lo.nn <br />WORK DESCRIPTION <br />Rcmm e Rcpl;irr l ius R'alc� I lc:tlrr <br />_._____ WATER CLOSET <br />______ BATHTUO <br />______ LAVATORY (YVASH BASIN) <br />______ SHOWER <br />____ KITCHEN SINK 8 DISPOSAL <br />_____ DISHWASHER <br />______ LAUNDRY TRAY <br />_____ CLOTHES WASHER <br />_____ URINAL <br />______ DRINKING FOUNTAIN <br />______ FLOOR DitAIN <br />____ _ _ BACKFLOW PREVENTER <br />______ SINK �SERVICF_�BAR/MOPlETC.� <br />OTHER <br />PIum6lnp WORK <br />Slpn TYPE <br />PHONE <br />�,��q��qU-Shll <br />PHONE <br />d25 H14-71_'d �lil <br />CONTR.LICENSE# <br />f:�tiT1t'ill�n521H' <br />n'; I �, 'un5 <br />OF EVERETT LOCAL SALES TAX <br />_______ AIC-A/HANDLING UNITS <br />_______ FORCEO AIR SYSTEMS <br />_______ HEAT PUMP <br />______ UNIT HEATERS <br />______,. CLOTHES DRYER <br />__ _ RANGE HOOD <br />__ _�__ WATER HEATER <br />�_____ METAL FIREPLACE/STOVE <br />_____ FIREPLACE INSERT <br />______ .r'iA5 FIREPLACE <br />�___ CAS RANGE <br />__,_ GAS PIPING <br />_____ EXHAUSi FAN <br />OTHER <br />SOURCE <br />fclnc <br />I HE REE3Y CCRTIFY TFiAT I HAVF READ AND EXAMIP:ED THIS APLICATION AND KNOW TH8 SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS ANO ORDINANCES GOVERNING TNIS TYPE OF WORK WIIL BE COMPLIED WIHT WNETHER SPECIFI[D HEREI� <br />OR NOT. TME GRANTING OF A PERMIT DOES N07 PRESUME TO GIVE AVTIIORITY TO VIOLATE OR CANCEI TI1E PROVISION OF ANV <br />OTHER STA1E OR LOCA� l/1W REGULATING CON57RUCTION OR TME PERFORMANCE OF CONSTRUCTION. THAT IAMAUTHORIZED <br />BY TME OWN[R OF T�iIS PROPERTY TO P[RFORM THE WORK FOR WHICH APPLICA710N IS MADE AND 1 COMPLV WITH THE STATE <br />CONT2ACTORS LAW 18.21 RCW ANU 296700 WAC. <br />aturo of OwnorlContraUorlAuthorixod Agam �... �_ -" �eto <br />� ,- �e �- c Y- ul ls �nu.l <br />ui �:� <br />