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,-� f-RMIT APPLICAT: �N <br /> � CITY OF EVERETT PERMIT SERVICES <br /> .. %� 3200 CEDAR STREET, EVERETT, WA 98201 , 425-257-8810 <br /> p� c�:z��� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> I�0� LOMI�ARD AVI:, EVGRGIT. WA 98201 00475431300300 i,�n �-3-�� �� <br /> 1�'� ���'-� � . )�-- <br /> LEGAL LOT NO. BLOCK ITP.ACT <br /> DESC <br /> OWNER ADDRESS PNONE <br /> ISOS LOMI3ARD AVG <br /> 101�I�S, SARAIi (435j4d3-2337 <br /> • GVGRI�I"1', WA 98201 <br /> TENAN7 NAME CONTACT NAME PHONE <br /> i�nMri.niiu.i_ a�s sw-�iz� .i» <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> rnsrwnrrrziirnriaicoMi�n�v iacoi isaNnnvr_Ne <br /> rnsrwi icosz�r <br /> KIRKLAND. WA 98034 p�!IG�2007 <br /> (425)8 W-3124 <br /> PROPOSED USE OF BUILDING eulldina Mechan�ca Addition HEAT SOURCE <br /> PERMIT Combinalion Plumbing WORK qltoration �Electric <br /> 7'ypE eDomolilion Sign TYPE New as <br /> S rlakl r Re atrMlalnl thcr <br /> CON7RACT PRICE OF WORK 5a:�y.pp CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION <br /> Rcmove/Replace Gas Water Heater <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _______ WATER CLOSET _______ A/C-A/HANDLING UNITS <br /> ____ BATHTUB ______ FORCED AIR SYSTEMS <br /> ____ LAVATORY (1NASH BASIN) ____�_ HEAT PUMP <br /> ___ SHOWER ___ UNIT HEATERS <br /> _______ KITCHEN SINK $ DISPOSAL _______ CLOTHES DRYER <br /> ___ DISHWASHER __ _ RANGE HOOD <br /> ____ LAUNDRYTRAY __�__ WATERHEATER <br /> _,_ CLOTHES WASHER ____ METAL FIREPLACEISTOVE <br /> ___ URINAL _�__ FIREPLACE INSERT <br /> �_ DRINKING FOUNTAIN ___ GAS FIREPLACE <br /> ____ FLOOR DRAIN _�_ GAS RANGE <br /> ____ BACKFLOW PREVENTER ___ GAS PIPING <br /> ___ SINK (SERVICE/BARIMOPIETC.) ___ EXHAUST FAN <br /> ----- OTHER---- -- ----- OTHER------------------------ <br /> i I HEREBY CERTIFY THAT I HAVE REAU AND EXAMINEO TH�S 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 PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED <br /> BY THE OWNER OF THIS�ROPERTY TO PERFORM THE WORK FOR WHICH APFLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> Si�7nalure of OwnedContractorlAuthorized Ageni : �- , :._'� Date 09/2005 <br /> R5� a�i <br />