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From: 09/10/2009 09:28 q926 P.003/003 <br /> � <br /> dF ain�CV�a� <br /> PEF�MIT APPLICATiON 457906 <br /> CITY OF EVERETT PERMIT SERVtCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> 426-257-8857 FAX <br /> SITE ADDRESS. _ PARCEL TAX I.D.# PERMIT# <br /> 11126 EVERGREEN WAY,EVERETT,WA 98204 ' - O�� <br /> LE(iAL LOT NO. BLOCK TRACT <br /> OWNER AODRE3S PHONE ' . <br /> 112 ST DINER 1 I 126 EVERGREEN WAY (425)347-3977 <br /> • EVERETT,WA 98204 <br /> TENANTNAME CONTACTNAME PHONE <br /> POLIMENAKOS,BILL(OWNER) Carol Randall 425-636-7054 <br /> CONTRACTOR ADDRESS CONTR.LICENSE� <br /> FAST WATER HEATER COMPANY 12601 132ND AVE NE FAS'T'W WI{9488C <br /> 425-636-7054 K«-AND,WA 98034 01/04/2010 <br /> PROPOSED USE OF BUILDING wiatnp wehame� Additlon H T SOURCE <br /> n � (} PERMIT Combinatlon plumelrp W0� Nt�raHon El�etrie <br /> �.D'MN'l�SLrCIL`-'C 7'YPE D�mollUon slpn TYPE Nwv aa <br /> R� IrMNnt � <br /> CONTRqCT PRICE OF WORK _ (o CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK �ESCRIATION Remove/Replace Gas Weter Hcater <br /> PLUMBING MECHANICAL <br /> N • OF U E OR ITEM N OF U OR ITE <br /> ,_ WATER CLOSET A/C-AIHANDLIN6 UNITS <br /> ___ BATHTUB � PORCED AIR SYSTEMS <br /> ______ LAVATORY(WASH BASIN) � HEAT PUMP <br /> __� SHOWER UNIT HEATERS <br /> ____ KITCHEN SINK 6 DISPOSAL CLOTHES DRYER <br /> __ DISHWASHER ^ RANGE HOOD I <br /> ___ LAUNDRY TRAY 1 WATER NEATER <br /> _�_ CLOTHES WASHER METAL FIREPLACGSTOVE <br /> ___ URINAL FIREPLACE INSERT <br /> ___ DRINKING FOUNTAIN OA3 FIREPLACE <br /> ___ FLOOR DRAIN GAS RqNOE <br /> _�__ BACKFLOW PREVENTER GAS pIpING <br /> ____ SINK (SERVICEIBARIMOP/ETC.) EXHAUST FAN <br /> ---- OTHER _� OTNER- -----�- <br /> 1 FiEREBYCERTIFY THAT I HAVE READ AND EXAMINED THiSAPLICATION AND KNOW THE SqME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WIHT WHETHER SPECIFIED NEREI <br /> OR NOT.THE GRqNTING OF A PERMIT'DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION pF'ANY <br /> OTHER STATE OR LOCAL LAW REGUUITING CONSTRUCTION ORTME PERFORMANCE OF CONSTRUCTION.THAT I AMAUTHOkIZED <br /> BY 1HE OWNER OF THIS PROPERTY TO PERFORM THE WORK POR WMICH APPLICATION IS MADE AND 1 COMPLY WI7H THE SThTE <br /> CONTRHCTORS LqW 18,27 RCW AND 298.200 WAC. <br /> Signaturs of OwnerlContractor/Authorized Ayent �,9�,���„�Qp ��t� 09/10/2009 <br /> -- - - / <br /> ui�m <br />