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Sent By: HP LaserJet 3100; 4258249518; Dec-15•05 1 :44PM� Page 3/3 <br /> ,-� PERMIT APPLICATIO�V <br /> � ClTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-25T-8810 <br /> �Zisos <br /> SITE ADDRESS PARCEL TAX I.D.* PERMIT� <br /> i I 12ti EVF.R(iREEN WAY,FVER�'fT,WA 98204 U0442900J0��700 �„�1 z-oZ, <br /> LEOAL l.OT Nd. BLpCK ITRAC7 <br /> OWNER ADOREBS �� PMONE <br /> 11126 EVF.R(iRL'L�N WAY (q?,S)747•3977 <br /> 112 S'1'UIN�R � C•VL�RETT,WA 98204 <br /> TENANTNAME CONTACTNAME PHONE <br /> PULIMF.NAKUS,[3I1.1.(OWNL•'R) pApq�.i.A HILL 425 R14-3124 x133 <br /> CONTRACTQR ADDRESS CONTR.LICENSEM <br /> FAST WA1'tlt HP.ATER CUMPANY 12601 132NU AVL•NE FASTW11C052DF <br /> K1RKI.ANU,WA 98031 0�16/?007 <br /> (425)814-3124 <br /> PROPOSED USE OF BUILDINO �W�a�'o N•�nanioa nadn�on T 80URCE <br /> PFRMIT COmbhuqon F'lumbinp WORK Nytiyp� NcMa <br /> TYPE D�mWilion :Npn �PE Nwn • <br /> b kl�Wnl K <br /> CONTRACT PWCE OF VUORK 5449.00 �ITY OF EVER�TT IOCAI bALES TN�COD61S]106 <br /> WORK DE3CRIPTION RcmovelReplace Ges Water Hcacer <br /> �� MECHANICAL <br /> OF IRTURE OR ITEM TYP�,no �IYTIIR[tlR ITCM <br /> WATEiI GLOSET �___ A1C•AlNANOLINa UNiTS <br /> � BATHTUB ,�__ FORCED AIR SYSTEIAS <br /> LAVATORY (WASH BASIN) ______ MEAT PUMP <br /> � SHOWER �__ UNIT NEATlRS <br /> �� KITCHlN SINK 6 DI9P09AL ___ CLOTNBS DRYER <br /> DISHWASHER ____ __ W►NGE MOOD <br /> LAUNDRY TRAY 1__ WATER MEATER <br /> CLOTHES WASFIER R_ METAL FIREPLACEISTOVE <br /> URINAL _�_ P�REPIACE INSERT <br /> T DRINKINCi iOUNTAIN _ OAS FIREPLACE <br /> ^ FLDOR DfWN ��_ GAS RANOE <br /> � BACKFLOW PREVENTEIi GAS P�pMd6 <br /> SINK (SERVICEIBARlMOPIE7C.) ______ E7(HAUST FAN <br /> '� OTHER _ _„�_ OTHER�,���_—�____ <br /> I HEREBY GERTIFY THAT I NAVQ READ AND E•%AMINEO TH�S APLICATION AND KNOW irtE SAME 70 BE TRUE AND CARRECT.ALL <br /> PRPVISIONS OF LAWS�NO OR�INANCES G4VERNIN6 THIB TYPE OF WORK WILL BE CaMPL16D WIHT WMETHER SPECIFIED MEREI <br /> pR NOT.T�fE 6RANTING OF A PERMR DOES NOT PRESUME To GIVE AUT�10RI1v TO VfOIATE OR CANCEL THE PROVISION OF nNY <br /> BY TH8 OWNER Q�H 5 PROPER�I'OTPERPORM THE WORK FOR WNIC i AFF�LICNATION IS MAOE ANO���Y W MH��ATE <br /> C,pryTRACTORS LA��1B.27 r7CW HND 296.20t1 WAC. <br /> Dale <br /> Siynewre o(�nodControcWrlAuthori:od Apem �.�Y:'���-__���;;;=��;.�` 12/I52Uu5 <br /> � �fl.Ni <br />