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Sent By: HP LaserJet 3100; 425824951G; Jun-27-06 12:46PIA; Page 4/4 <br /> f-�� PEkiVIIT APPLICATION <br /> ClTY O�F EVERETT PER�JIIT SERVICES <br /> „_ 3200 CEDAR STREET, EVERETT, WA 98201 , 425-257-8810 <br /> o��z�oc <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 4903 FOR'LCRAVF., Ev�kL•TY, �VA 9R203 00394G00o0:700 ,�n � O� _� l <br /> / I � <br /> LEGAL LOT NO. BLOCK ITRACT <br /> D <br /> OWNER ADDRESS PHONE <br /> 490;4 FOWLER A V� <br /> 5CII\EIDF.R, LIAVID (�i2S)25g-45G3 <br /> • EVERETT. WA NS"LU3 <br /> TENANT NAME CONTACT NAME PHONE <br /> YAMELA H1LL .��5 RI�1-31'4 �1:� <br /> CONTRACTOR ADDRESS CONTR,LICENSE# <br /> FAST W:�THR HL'ATER COMPANY 126U1 133ND AVF.�1G FAST�4'\VI k14RRC <br /> KIItKLA`ID. WA 9SU}.. U1IUJ/200R <br /> (J2$)81d•3124 <br /> PROPOSED USE OF BUILDING ewldtnp hlachenlce W�RK Addltlan H T SOURCE <br /> PERMIT Combination PIumGMg Alleration Electnc <br /> TYPE o�mollllon Elyn NPE Naw ac <br /> r r R� alrlMalnl tber <br /> CONTRACT PRICE OF WORK $449.00 41iY OF EVERETT LOCAL SALES 7AX COOEIS a105 <br /> W�RK DESCRIPTION kemove/Rcplace Gns Wnter Henter <br /> PLUMBING ME('�[iNICAL <br /> TYPE OF F TUR OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ___ WATER CLOSET ______ NC-AIfiANOLING UNITS <br /> ____ BATHTUB �____ FORCED AIR SYSTEMS <br /> ___ LAVATORY(WASH BASIN) ______ HEAT PUMP <br /> ____ SfiOWER �„_ UNIT HEATERS <br /> ____ KITCFiEN SINK 6 OISPOSAL ______ CLOTHES DRYER <br /> DISF{WASNER _ _ RANGE NOOD <br /> �_ LAUNDRYTR.4Y __,�__ WATERHEATER <br /> _,_ CLOTFiES WASHER _�_ METAL FIREPLACEISTOVE <br /> .^__ URINAL ._____ FtREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FIOOR DRAIN __�_ GAS RANGE <br /> u_ BACKFLOW PREVENTER __` GAS PIPING <br /> _� SINK (3ERVICFJBARlMOP/E'fC.) �,_____ EXHAtJST FAN <br /> __---_ OTIIER��_ —��_ 07HER-------------------- <br /> 1 HEREBY CERTIFY TFiAT�HAVE REAO AND EXAMINED THIS APLICATION A'J�KNOW THE SAME TO 8[TRUE AND CORRECT.ALL <br /> pROVISIONS OF LAWS ANO ORDINANCES GOVERNING 7FiIS',YPE OF WOftK WILL BE COM1IPLIEO WIHT WHETHER SPECIFIED HEREI <br />� pR NOT.THE GRANTING OF A PERMI7 OOES NOT PRESUME TQ GIVE AUTI IORITY TO V104nTE OR CANCEL THE PROVISION OF ANY <br /> O7HER STATG OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.THqT I AM AUTHORIZED <br /> BY THE OWNER Of iHIS PROPERTY TO PERFORM THE WORK FOR WHICI I APPLIGATION IS MN�E AN6 I COMPLY WITH THE STqTE <br /> CONTRACTORS LAW 10.27 RCW AN�2�J8.200 WAC, <br /> Siynaturo of OwncrlContfactorlAuthofiz9d Apani r,,..-:.���_�.; ��;r�'r;..y.-. Date ���7/2UU6 <br /> U�,�� <br />