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�z <br /> Sent By: HP LaserJet 3100; 4258249516; Jan-29•06 11 :57AM; Page 3/4 <br /> ,- P�RMIT APPLICATION <br /> �i��� CITY OF EVERETT pERP1AIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8610 <br /> oiz9u�� <br /> SITE ADDRESS PARCEL TA1(I.D.� PERMIT* <br /> 4611 FOWLER AVE,FVFRFTT,WA 98203 00412000201700 �p[pp �_�j7� <br /> LEGAL LOT HO. BLOCK TRAC7 <br /> OWNER ADDRESS PHONE <br /> BICiI.F.R,KA'f HI.I:h:N 46111''UWL�1tAV� <br /> • BVLRL•TT,WA 98203 (-125��52-7);9 <br /> TENANTNAME CONTACTNAME PHONE <br /> YArfl'!.�H1LL 425 R14-31?S x133 <br /> CONTRACTOR ADDREs; CONTR.LICENSE# <br /> �ASTN'ATERHF.A'I'bRCQMPANY 1260t 132rDAVENE r•nSTw�vlP�axuc <br /> (425)8�5-312J w��LAND,WA 980?•. 01/03R006 <br /> PROPOSflD USE OF BUILDING eunar�p nw�n.,ioa aee�uon H T SOURCE <br /> PERMIT Combin�tlon F'Iumbiny WORK N��go� Ekctric <br /> IYPE D�mollNon ilpn �'PE N�w 6os <br /> � R� afrMdN Olh�r <br /> CONiRqCT PRICE OF WORK 5qqy.UU CITY OF EVERlIT LOCAL SAI.ES TAX CODEIS 3105 <br /> WORK DESCRIPTION Rcmove/Replace Gas Water IIeater <br /> PLUMBING MECHINICAL <br /> N . I I Ty F I T 1 <br /> _____ WATER CL03ET A!C•A/MANDLINO UNiTS <br /> __�__ BATHTUB FORCED AIR SYSTEMS <br /> _____ �y�1TORY(WASM 6ASIN) ,Yr HEAT PUMP <br /> _._ SHOWER _Y UNIT HEATERS <br /> _�_ KITCMEN SINK 3 DISPOSAL CLOTHES DRYER <br /> �_ OISHWASHER � RANOE HOOD <br /> ____ LAUNDRY TRAY � WATER HEAT�R <br /> ____ CLOTMES WASH6R _ AIETAL FIREPLACE/STOVE <br /> ___ URINAL � FlREPLACE INSERT <br /> �__ DRINKINa FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN �� GAS RANGE <br /> _____ BACKFLOW PREVENTER Q,qS p�piNo <br /> __� SINK (9ERVICFJBAR/MOPIETC.) __ EXHAUST FAN <br /> �__ OTHER OTHER-----�- <br /> 1 FiEREBYCERTIFYTHAT I NAVE READ AND EXAMtNGD THIS APLICATIDN qtlD KNOW 7HE SAME TO BE TRUE AND CORRECT,ALL <br /> PROVISIONS OF L�WS ANO ORDINANCES GOVERNING THIS TYPE OF WOF:K N7LL 8E COMPLIFO WIHT WNETMER SPECiFtEO NGREi <br /> OR NOT,IHE GR4NTING OF A PERIAIT DOES NOT PRESUME TO GNE AUTh�ORITY TO VIOLATE OR CANCEL TNE PROVISION pF ANY <br /> OTMER STATE OR LOCAL LAW RECUt.4tINC CONSTfiUCT10N OR TMB vER��ORMANCE OF CONSTRUCTION.THATI AIJ AUTH�(i1ZED <br /> BY THE OWNER OF TMIS PROPERTY TO PERFORM THE WORN FOR WMlct�qPPLICATION IS MADE A�01 COMCLY WITH TME STATE <br /> CON7RACTORS UW iB27 RCW AND 296.200 WAC. <br /> Signature of Own�UContracror/Authorl1otl Aganl _�,_:.����.,-- � - D�te <br /> • ^� =L =�c"�'s' 01/2)':OOfi <br /> ui.ni <br />