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,,-��� P[ �MIT APPLICATIQ.J <br /> �,i?� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> CK I956 <br /> SITE ADDRESS PARGEL TAX I.D.# PERMIT# <br /> 10125 DAKOTA \VAY,EVERGTT,WA 98204 00552400601800 �j� _ � <br /> U <br /> LEGAL LOT NO. BLOCK ITRACT <br /> DE <br /> OWNER ADDRESS PHONE <br /> LGWIS, LOVDA 10125 DAKOTA WAY � �90-5940 <br /> • EVGRGTT, WA 98204 (4_5)_ <br /> TENANT NAME CONTACT NAME PHONE <br /> PAMELAHILL 425 SI-0-31?4r133 <br /> CONTRACTOR AODRESS CONTR.LICENSE# <br /> FAST\VATER HEATGR COMPANY 12601 132ND AVE NG <br /> PAST W IiC052 D� <br /> (425)81-0-3124 KIRKLAND, WA 98034 02/l6/?005 <br /> PROPOSED USE OF BUILDING Buildinp M�ch�nica WORK Addition HEAT SOURCE <br /> PERMIT Comhlnatlon Plumbinp Il':�ra6on El�etric <br /> TYPE D�moliUon S�pn TMPE Naw as <br /> r R� eIMNa1N lher <br /> CONTRACT PRICE OF WORK $349.00 CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION Remove/Rcplacr, Electric Watcr Heater <br /> PLUMBING MECHANlCAL <br /> NO. PE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ______ WATER CLOSET ______ A1C-AIHANDLING UNITS <br /> _�___ BATHTUB �_�_ fORCED AIR SYSTEMS <br /> _ _____ LAVATORY (WASH BASIN) __v_ HEAT PUMP <br /> _ �_ SHOWER ___ UNIT HEATERS <br /> ___ KITCHEN SIkK 6 DISPOSAL ____ CLOTHES DRYER <br /> __ DISHWASHER _ _ RANGE HOOD <br /> ___ IAUNDRYTRAY � 1__ WATERHEATER <br /> ___ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> ___ URINAL _�_ FIREPLACE INSERT <br /> _�_ DRINKING FOUNTAIN ___ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> ____ BACKFLOW PREVENTER __ GAS PIPING <br /> _� SINK (SERVICE/BAR/MOPlETC.) ___ EXHAUST FAN <br /> ____ OTHER_ ___ OTHER____�_____�_______� <br /> I 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 WILL BE COMPLIED WIHT WHETHER SPECIFIED HEREI <br /> OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO�ISION OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED <br /> BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH TME STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> Signature of OwnedContraetorfAuihorizad Ageni ��-; �� ��•�: i.-. Oate OI/20/2005 <br /> u�.ni <br />