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P'"RMIT APPLICATi "'N <br /> CITY OF EVERETT PERMIT SERVICES <br /> ..... 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> o�zoor> <br /> SITE ADDRESS PARCEL TAX 1.D,# PERMIT# <br /> 1C09 FNGLAAIp AVE, EV£RETT, �VA 98'03 29043t0040300�) y� <br /> 1 ►I ��p�J7—CJJ� <br /> LEGAI. LpT NO. BLOCK ITR�CT <br /> DE <br /> OWNER ADDRESS PHONE <br /> C.4RLSTROM.PAUL 1609 E�IGLAND AVE (425)355-3R00 <br /> • EVERETT, WA 98203 <br /> TENANTNAME CONTACTNAME PHONE <br /> PAMELA HILL 425 8l4•3124 x133 <br /> CONTRACTOR ADDRHSS CONTR.LICENS�# <br /> 'AST WATER IiEATE[t COMPAA`Y I260I 132ND AVL•NE FASTW WH946BC <br /> (425)814-3124 KIRKLAND,W� y803A Ol/03/2005 <br /> ?R�POSED USE OF BUILDING Dulldinp Meehanlea WORK Additlon H AT SOURCE <br /> PERMIT Combinatlan Plumbin0 AltaraUon Elactric <br /> TYPE D�motilan Sign Np� New ac <br /> � Re IrlMalnt tnCr <br /> CONTRqCT PRICE OF WORK 5449.U0 CIiY OF EVERETT LOCqL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION Remove/Replace Gac Water Heater <br /> PLUMBING MECHANICAL <br /> NO. OF FIXtUR O I EM NO. TYpE OF FIXTURE OR ITEM <br /> ._..__ WATER CLOSET A/C-A/HANDLING UNITS <br /> ___ BATHTU6 � FORCEO AIR SYSTEMS <br /> ____ LAVATORY (WASH BAS�N) � HEAT PUMP <br /> _^ SHOWER �� UNIT HEATERS <br /> _____ KITCHEN SINK $ OISPoSAL �� CLOtHES ORYER <br /> ___� DISHWASHER � RANGE HOOD <br /> _ �.� LAUNDRY TRAY ~1 WATER HEATER <br /> _�_ CLOTHES wASNER ' METAL FIREPLACEISTOVE <br /> �_ URINAL � ~ FIREPLACE INSERT <br /> DRINKING FOUNTAIN J � GqS FIREPLACE <br /> _ FLOOR DRAIN GAS FtANGE <br /> _�.__ BACKFLOW PF2EVENTER � � GAS PIPING <br /> _____ SINK (SERVICEIBAR/MOPlETC,) �fHAUST FAN <br /> ____ DTHER_ ��_ OTHER <br /> I HERE9Y CERTIFYTHAT 1 NAVE READ AND EXAMINEO THIS APLICATION AN�KNOW THE SAME TO BE TRUE AND CORRECT,ALL ^ <br /> PROVISIONS OF LAWS AN�ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIeD WIHT WHETHER SPECiFIED HEREII <br /> OR NOT.THE ORANTING OF A PERMIT DOES NOT PRESUME TO OIVE AUTHORIiY TO VIOLA7E OR CANCEI.THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION pR THE PERFORMANCE OF CONSTRUC710N.THAT I AM AUTHORIZED <br /> BY THE OWNER Of THIS PROPERTY TO PERFORM hiE WORK FOR WHICH APPL�CATION IS MAOE AND 1 COMPLY WI7H TIIE SiATE <br /> CONTRSCTORS LAW 18,27 RCW ANO 290.20�WAC, <br /> Signoturo of OwncrlCaneractorlAuthorizod Ageni r.r:��� ' � Dete <br /> .� — — �v%�`--�`� 07l20/200G <br /> U�!RI <br />