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;-�-� F -RMIT APPLICATt )N <br /> �'"� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR[ET, Eb`ERETT, WA 98201, 425-25'••8810 <br /> c�:�ssa <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 50?S BVBRGRCC•N VVAY, BVERGTT, WA 98203 29053100401400 M05�S- G59 <br /> LEGAL LOT NO. BLOCK ITRACT <br /> DE <br /> OWNER ADDRESS PHONE <br /> CASA TGQUILA 5028 EVCRGRGGN V✓AY � <br /> • HV6RGTT, VVA 98203 (�='�)-58-69�15 <br /> TENANT NAME CONTACT NAM� PHONE <br /> PAMELA NILL 425 314-312-. <133 <br /> CONTRACTOR ADDRESS GONTR.LICENSE# <br /> PAST\VATHR FIEATHR COMPANY 12601 I32ND AVE NG FASTWIiC05?Dt <br /> (425)814-3124 KIRKLAND, WA 98034 02/IG/2007 <br /> PROPOSED USE OF BUILDING euiminp Mechanlca Addi�ion HEAT SOURCE <br /> PERMIT ComL+inatlon Plumbing �ORK , q�teratian �Electric <br /> '�ypE Damolition Sign T�'PE New as <br /> rinkl r Re airlMalnt ther <br /> CONTRA�T PRICE OF WORK $qqy.00 CITY OF EVERETT LOCAL SALES TAX CODEI; 3105 <br /> WORK DESCRIPTION Remove/Rcplace Gas�Vater Heater <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ______ WATER CLOSET ______ A/C-AIHANDLING UNITS <br /> _____ BATHTUB _____ FORCEO AIR SYSTEMS <br /> _______ LAVATORY (WASH BASIN) __�_ HEAT PUMP <br /> __�__ SHOWER ___ UNIT HEATERS <br /> ______ KITCHEN SINK & DISPOSAL ____ CLOTHES DRYER <br /> ______ DISHWASHER __ _ RANGE HOOD <br /> ______ IAUNDRY TRAY __�__ WATER HEATER <br /> ___ CLOTHES WASHER _� METAL FIREPLACE/STOVE <br /> ___ URINAL ____ FIREPLACE INSERT <br /> __ DRINKING FOUNTAIN ___ GAS FIREPLACE <br /> , FLOOR DRAIN GAS RANGE <br /> _____ BACKFLC:!� PREVENTER __ GAS PIPING <br /> _�_ SINK (SERVICJBARIMOP/ETC.) ___ EXHAUST FAN <br /> �___ OTHER__ OTHER______________ __ <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WIHT WHETHER SPECIFIED HEREI <br /> OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TU GNE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL I.AW REGULATING CONSTRUC710N OR THE PERFORMANCE OF CONSTRUCTION,THAT�AM AUTHORIZED <br /> BY THE OWNER OF THIS PROPERTY TO PERFORM THE 1M1'ORK FOR WHICH APPLICATION IS M11ADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW ANO 296.200 WAC. <br /> Signature of OwnedContractorlAuthorized Ageni �_. -�� �j'�_ �. Date OS/25/200> <br /> ■si?ni <br />