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frum: 01/02/2007 11:29 AU04 P.002/002 <br />PERMIT APPLICATiON �_2��� <br />CITY OF EVERET�' PEfiMIT SERVICES <br />._ 3200 CEDAR STREET, EVERETT', WA 98201, 425-257-8810 <br />0102U7 <br />SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br />1805 MADISON ST, GVERET"f, WA 98203 0053I600001900 <br />/%I7Ci -C��/ <br />LEGAL LOT NO. BIOCK TRACT � <br />DE C <br />OWNER ADDRESS �. PHO�YC- <br />SLOANE, KAREN � $�5 MADISON ST <br />• EVEIifiTT, \i�A 98203 (206)2343747 <br />TENANT NAME CONTACT NAME PHONE <br />Carol Randall 800 425-814-8381 x 1 <br />CONTRACTOR ADDRESS � CpNTR.LICENSE# <br />FASTWA'CIKFIEATERCOMPANY 12601132NDAVENE ` \,1�1� FASTIVWH948UC <br />(425)814-3124 <br />KIRKLAND, WA 98034 C � I ��"' Ol/03/2008 <br />PROPOSED USE �F BUILDING Bulldinp Meehanica Addillon HEAT S6URCE <br />P�RMIT Combination PlumbinB W�RK p,��eretton Electric <br />'[YpE Damolllion Slpn TYPE Naw as <br />rin Re aldMaint ther -� <br />CONTRAC7 PRICE OF WORK $449.00 CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br />WORK DESCRIPTION Remove/[teplace Gns Water Heater <br />pLUMBING MECHANICAL <br />NO. E OF I U OR ITEM NO. TYPE OF F XLURE OR ITEM <br />____ WATER CLOSET _�__ A/GA/HANDLING UNITS <br />___.___ BATHTUB �,^__ FORCED AIR SYSTEMS <br />____� LAVATORY (WASH BASIN) _ HEAT PUMP <br />______ SHUWER _� UNIT HEA7ERS <br />_____ KITCHEN SINiC & OISPOSAL ____ CLOTNES DRYER <br />�_ DISHWASHER _ RANGE HOOD <br />,� LAUNDRY TRAY � 1 _ WATER HEATER <br />_ CLOTHES WASHER METAL FIREPLACEISTOVE <br />_�_ URINAL _ FiREPIJ�.CE INSERT <br />_ ORINKING FOUNTAIN QAS FIREPLACE <br />FLOOR DRAIN GAS RANGE <br />___ BACICFLOW PREVENTER �_ GAS PIPING <br />_ SINK (SERVICE/BARlMOP/E7C�) _�_ EXHAUST FAN <br />___ OTHER� _ OTHER___��Y <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAM1SI�:'o THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL � <br />PROVISIONS OF LAWS AND ORDINANCES GOVEf2NSNG THIS iYPE OF WORK WILL BE COMPLlEO WIHT WHETHER SPECIFIED HEREI <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTNORI7Y TO VIOLATE OR CANCEL 7HE PROVISION OF ANY <br />OTNER STATE OR LOC�\L lAW REGULl�TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TMAT I AM AUTHORIZE� <br />BY i HE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTFinCTORS LAW 1d.27 RCW AND 298.200 WAC. <br />Signaturo of OwneNContraetor/Autharizad Agonl �t-:�� ,,- ��� �.f,: . Date O1/02/2007 <br />ny� oai <br />