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from: 04/15/2D09 13:53 A121 P.UO2/UO2 <br /> i <br /> PERMIT Ai�PLICATION 440859 � <br /> ClTY OF EVERETT PERMIT SERVICES <br /> .._ 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> 425-257-8857 FAX ���j <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 1102 LOMBARD AVE,EVERETT,WA 98201 29051700207400 nn <br /> /v � �D _ 6=1Co <br /> LEGAL tOT NO. BLOCK TRACT <br /> DE C � <br /> OWNER ADDRESS PHONE 'p <br /> MOORE,CAROLYN 1102 LOMBARD AVE (q?5)252-2487 <br /> • EVERETT,WA 98201 ` <br /> TENANT NAME CONTACT NAME PH1�NE <br /> Carol Randall 425-636-7054 <br /> CONTRACTOR ADDRESS CONTR.LICENSEii <br /> FASTWATERH�ATfiRCOMPANY 12601132NDAVENE FASTWWI�948DC <br /> KIItKLAND,WA 98034 C U04R010 <br /> 425-636-7054 <br /> PROPOSED USE OF BUILDING Bulm�ay M�chanica WORK �d�tion H T SOURCE <br /> PERMIT Combinetion plumbinp AllanHon etrie <br /> TYPE Demolltion Slpn TYF'� Naw as <br /> rin e Re alrMlainl ther <br /> CONTRACT PRICE OF WORK $349.00 CITY OF EVERETT LOCAL SALES TAX COU_IS 3'105 <br /> WORK DESCRIPTION Remove/ReplaceElectric WuterHeater <br /> PLUMBING MECHANICAL _ <br /> O. TYPE OF FIXTUR I EM NO. P OF IXTUR R ITEM <br /> ______ WATER CLOSET __� A/C-A/HANDLING UNITS � <br /> __ BA7HTUB _�� FORCEO AIR SYSTEMS <br /> ____ LAVATORY(WASH BASIN) ______ HEAT PUMP <br /> __ SHOWER __ UNIT HEATERS <br /> ^_ KITCHEN SINK 8 DISPOSAL _ CLpTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> __ LAUNpRY TRAY �l,_ WATER HEATER <br /> `_ CLOTHES WASHER �_^ METAL FIREPLACEISTOVE <br /> _ URINAL _ FIREPIACE INSERT <br /> � DRINKING FOUNTAIN ___ LiAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> __ BACKFLOW PREVENTER __ GAS PIPING <br /> __ SINK (SERVICE/BAR/MOPlETC.) ___ EXHAUST FAN <br /> ___ OTHER _�_ OTHER_,__��,_„� <br /> 1 HEREBY CERTIFY THA71 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 GRANT1Ni;OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PkOVI510N OF ANY l <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.h1AT I AMAUTHORIZED ` <br /> BY THE OWNER OF TH(5 PROPERTY TO PERFORM THE WORK FOR WHICH APPLICA710N IS MADE AND I COMPIY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> Signaturo of Owner/Contractor/Authotizud Agent �a_ay���„�d� Date 04/15/2009 <br /> -- / <br /> uirm <br /> �4 <br />