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Sent By: HP LaserJet 3100; 425824951�; Jul-2fi-06 1 :18PId; Paye 2/4 <br /> PtRMIT APPLICATIUN <br /> ����� CITY OF EVERETT PERF�IIT SERVICES <br /> 32U0 CEDAR STREET, EVEF2ETT, WA 98201 , 425-257-8810 <br /> U72606 <br /> SITE ADDRESS PARCEL TA;C I.Q.# PERMIT# <br /> 12US LOhfDARD AVE,EVF.RF.TT, WA 98201 UU�4T2•IW:�UUU � �" /;� <br /> /�/c/C�/ — _> <br /> LEGAL LQT NQ. BI.00K ITRACT <br /> DE <br /> OWNER ADDRE3S PHONE <br /> ERICKSON, UOTv'ALD �Z�B LOMUAILU AVL �q�5j;3p-1627 <br /> � L'VERE'CP, WA 98201 <br /> TENANT NAME CONTACT NAME PHONE <br /> PAMiLA H1LL q25 814-3124 �113 <br /> CONT'RACTOR ADDRESS CONTR.LICEkSE# <br /> f AS'I' \��ATER IIEATF,R (:Oti1P�NY 12G01 172ND AVR NF. <br /> PASTlV14'I194RAC' <br /> (42S)g14-3t24 KIRKLAND,\�1'� 9303� Ol/03/2003 <br /> PROPOSED USE OF BUILDING eulltlinp Mechenice WORK ������� HFAT SOURCE <br /> PERMIT com�inatlon Flumbinq Altaretion Elactric <br /> TYPE Damolilion Slqn 7YpE Naw ae <br /> � Re a1rlMalnt �a� <br /> CONTRACT PRICE OF WORK $qq9.00 t:ITY OF EVERE7T LOCAL 5ALES 7AX CODEIS 3i05 <br /> WORK DE3CRIPTION Remove/Replace Gas Wncer IIeater <br /> PLUMBING 41ECNANICAL <br /> NO. TYPE OF FIXTUR ITEM VO. T PE OF FIXTURE OR ITEM <br /> __�__ WATER CL03ET ____ A!C-A/HANDLING UNI75 <br /> _____ 6ATHTUB ____ FORCED AIR SYSTEMS <br /> _ _^__ LAVATORY (WASH BASIN) _______ HEAT PUMP <br /> _____ SHOWER ____ UNIT HEATERS <br /> ____ lCITCNEN SINK $ oISPOSAL _______ CLOTNES DRYER <br /> __�,__ DISNWASHER __ _ RANGE HOO� <br /> __ l_AUNORYTRAY ___f__ WATER HEATER <br /> �___ CLOTHES WASHER �____ METAL FIREPLACE/STOVE <br /> ____ URINAI. ___ FIREPLACE INSERT <br /> _� DRINKING FOUNTAIN ,___,___ GAS FIREPLACE <br /> __ FLOOR DRAIN ___�__ GAS RANGE <br /> _____ BACKFLOW PREVENTEl2 ___ GAS PIPING <br /> ___� SINK {SERVICE/BAR/MOP/ETC.) ._�__ EXHAUST FAN <br /> �_ OTHER��� _^ r__�_ OTHER <br /> 1 HEREBY CERTIFY THAT I HAVE READ ANO EXAMIN[D THIS APLICATION A��KNOW THE SqME TO fiE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPe OF WOFK WILL�E cOMPL�EO WIHT 4YHE7HER SPECIFIEO 1'EREI <br /> pR N07, THE GRANTING OF A PERMIT DOcS NOT PRESUME TO OIVE AV711�JRITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATC-OR LO(:AL lAW REGULATING CUWSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION.THAT I AM AIJTHORIZE� <br /> BY THE OWNER OF THIS PROPERTY TO PERFORAI THE WORK FOR WHICN APPLICA710N IS nnn�E AND 1 COMP�Y WI7H TNE STn1�E <br /> CONTRHCTORS LAW 10,27 RCW AND 296.20�WAC. <br /> SlgnaWfe of Ow+nedContraetodAuthorized Apnm r.....:_�._ ,_., ;.-• _ .�,:-, Dato 07n6!200C <br /> w� a.9� <br />