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,- R. :RMIT APPLICATf��N <br /> fi��� CITY OF EVERETT PERMIT SERVICES <br /> F 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> CK I 524 <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT# <br /> 541 I COLL[GL' AVG[VGRETT.\1'A 98203 00443200000900 m Ot{��' _(�� <br /> LEGAL LOT NO. BLOCK TRACT <br /> E <br /> OWNER ADDRESS PHONE <br /> 541 I COLLLG[i A\'G (425)34R-9841 <br /> LOPIi"1_.Cf1GR1'L i <br /> • LVGRGI'l', 11'A Y8203 <br /> TENANT NAME CONTACT t�AME PHONE <br /> PAMGLA FIILL 425 814•3124 x133 <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> P:1ST 11'ATL•R IILATGR COMPANI' 12601 132ND AV[NE ��AST11'l IC052D1' <br /> (�1251�I�!-3 I 2a <br /> KIRKLA\U, R'A 98034 02/IGl2005 <br /> PROPOSED USE OF BUILDING Bulldinp M�oh��ie� WORK Addition H AT SOURCE <br /> PERMIT Combin�tion Plumbin Alleradon El�etrte <br /> TypE D�molilion Slpn T�'PE New as <br /> � R� alnMainl IAer <br /> CONTRACT PRICE OF WORK S449.00 CITY OF EVERETT IOCAL SALES TAX CODEIS 3105 i <br /> WORK DESCRIPTION Rcmo�c/Replacc Gas\Vatcr Hcaicr <br /> UM I MECHANICAL � <br /> NO. TYP OF FIXTURE R ITEM TYP OF IXTUR R ITEM <br /> WATER CLOSET AIC-A/HANDLING UNITS F <br /> BATHTUB FORCED AIR SYSTEMS f <br /> _______ LAVATORY (YVASH BASIN) ���= HEAT PUMP I <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK $ �ISPOSAL ______ CLOTHES DRYER ' <br /> ---- <br /> DISHWASHER __ _ RANGE HOOD <br /> LAUNORY TRAY _��__ WATER HEATER <br /> CLOTHES WASHER ____ METAL FIREPLACElSTOVE <br /> URINAL ____ FIREPLACE INSERT <br /> DRINKING FOUNTAIN ___ OAS FIREPLACE <br /> ~ FLOOR ORAIN �___ GAS RANGE <br /> BACKFLOW PREVENTER __ GAS PIPIN6 <br /> �_�_ <br /> SINK (SERVICEIBAR/MOPIETC.) ___ EXHAUST FAN <br /> ----- OTHER---- -- ---- OTHER----------------------- <br /> ��__ ---- ------ ----- ------------------------- <br /> ---- ------ ------ ------ ------------------------------I <br /> 1 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 Wlll BE COMPLIED WIHT WHETHER SPECIFIED HEREIf�� <br /> OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY I <br /> OTNER STATE OR LO(:AL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED <br /> BY TME OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE , <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> Signalure of OwnedContracrorlAuthorized Agem � �- Date „ � <br /> ��'= / �r %' 0_ I I;_004 <br /> RSI MI <br />