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,- F _RMIT APPLICATI�N I <br />����CITY OF EVERETT PERMIT SERVICES � <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8H10 � <br />CKIISO I <br />SITE ADDRESS PARCEL TAX I.D.# �ERMIT# � <br />,,,> �>t tiT S11'. f�'GRI'TT. �1'A 9K20J ��53�9�000�3�o rn�yo �-o� � I <br />__I <br />LEGAL LOT NO. BLOCK ITRACT <br />�e�� <br />OWNER <br />\1'ILLI:1A1ti, klAt <br />TENANTNAME <br />ADDRESS <br />719 93 ST S1V <br />erT_ wn eszoa <br />CONTACT NAME <br />PAMGLA IIILL <br />CONTRACTOR IADDRESS <br />P:\tiT �4'ATIiR III;.ATLR COMPANl' 12601 U2ND AVG N� <br />�4:5�x1a-)12a <br />PROPOSED USE OF BU <br />CON7RACT PRICE OF WORK Sq49.pp <br />KIkRLA4D, WA 9R014 <br />PHUNE <br />(425)355-9225 <br />425 N14-3124 xIJJ <br />CONTR.LIC�NSE# <br />I'AS'fWIIC052DP <br />02/IGl2005 <br />ounamp ^ M��^�^�o� WORK �amuon H T SOURCE <br />Combinallon Plumbin • Nt�ratlon El�clrte <br />D�mollllon 81yn TYPE N�w aa <br />Re Hr/MafM lher <br />CITY OF EVERETT LOCAL SALES TAX CODEIS 7105 <br />WORK DESCRIPTION Himu�aRcplacc (ias 1Vntcr Hcatcr <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISPOSAI. <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WA�HER <br />URINAL <br />DRINKING fOUWTAIN <br />FLOOR DRA�N <br />BACKFLOW PREVENTER <br />SINK (SERVICEIBAR/MOPIETC.� <br />OTHER____ <br />� <br />FCRCED 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 />OAS FINEPLACE <br />GAS RAN6E <br />GAS PIPINO <br />EXHAUSTFAN <br />OTH E R------ ---------- <br />----- 1 ---------------- � ----- � ------------------------- <br />HEREBV CERTIFY THAT I NAVE READ AND E%AMW[D THIS APLICATIG� AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />�ROVISIONS OF LAWS AND OR�INANCES GOVERNING 7HIS TVPE OF WORK WILL BE COMPLIED WIHT WHE7NER SPECIFIED MERE <br />iR NOT. THE GMNTING Of A PERMI7 DOES NOT PRESUME TO GNE AUTHORITY TO VIOLATE OR CANCEL THE PfiOVISION OF ANY <br />iTHER STP"E OR IOCAL LAW REGU�.hTINu CONSTRUCTION OR TME PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHOfiIZED <br />Y THE OW'JER OF TNIS PROPERTY TO PERFORM TME WORN FOR WMICH AP?IICATION IS AMOE ANO I COMPLV WITN TNE STATE <br />�.pNTRACTORS LAW 18.Y7 RCW AND 798.200 WAC. <br />Sipnelure of OwnedContnctorlAuthorized Apeni ��J� �!�„— D�t• �Z�����z��3 <br />