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SITE ADDRESS <br />P-RMIT APPLICATI �N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />12 - a--o <br />PAP.CEL TAX I.D.# <br />G2d MADISON ST, GVBRBTT, WA 98203 0039330000I002 <br />LEGAL LOT NO. BLQCK <br />DE <br />aWNER ADDRESS <br />rRl'G, JUDY G24 MADISON ST <br />• BVGRGTT, WA 98203 <br />7ENANT NAME CONTACT ►dAME <br />PAMGLA HILL <br />CONTRACTOR ADDRESS <br />PAS'P WA7'GR HGATER COMPANY 12601 I32ND AV8 NS <br />(425)814-3124 KIRKLAND, WA 98034 <br />PROFOSED US�C OF BUILDING 9ulldinp Aleehanfca <br />PERMIT Combina0on Plumhing W�RI <br />TYPE Damolition Slgn �YPE <br />r r <br />CONTRACT PRICE OF WORK $q49.00 CITY 7F EVERE <br />WORK DESCRIPTION Remove/Replace Gas Water Fleater <br />� <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK $ DISPOSAL <br />GISHWASHER <br />LAUNORY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BARlMOPlE7C.) <br />OTHER <br />1 <br />CK 1784 <br />PERMYf# <br />9l�-� <br />PHONE <br />(425)353-5900 <br />PHONE <br />425 814-3124 x133 <br />CONTR.LICENSE# <br />PASTNFtC052D� <br />02/I6/2005 <br />..uoiaon HEAT SOURCE <br />AlteraUon DElectric <br />New as <br />Re afrlMaint ther <br />AL SALES TAX CODEIS 3105 <br />�vc:•aJHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />'ROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WIHT WHETHER SPECIFIED H[RE <br />>R NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />)THER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED <br />iY TME OWNER OF THIS PROPERIY TO PERFORM 7HE WORK FOR WHICH APPLICATION IS MADE AND 1 CCMPLY WITH THE STATE <br />;ONTRACTORS LAW 16.27 RCW AND 296.20D WAC. <br />ro of OwnerJContractor/Authorized Agoni �,. - ,, ✓:_•�_ � Date � ��30/2004 <br />ui oai <br />