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Froo: 05i�4l2006 18:06 H363 P.003/U06 <br /> PERNl11r �'�PPLlCATI�IV aoao5s <br /> �;i�� CITY OF EVERETT PERMIT SERV��CES <br /> 3200 CEDAR STREET, E.VERETT, WA 98201, 425-257-8810 <br /> 425-257-8857 FAX 5-),5�U� <br /> SITE ADDRESS PARCEL TAl:I.D.� PERMIT# <br /> 10030HOLLYDRtt101,EVERETT,WA 98204 00858501010100 /' <br /> U.� � � <br /> LEG,4L LOT NO. BLOCK TRACT. <br /> . <br /> OWN�Ft ADDFtESS pHONE <br /> GOERG,DAVE 1003U HOLLY DR BIOI (Zp6)229-4072 <br /> • EVERETT',WA 98204 <br /> TENANT NAME CONTACT NAME PHONE <br /> Carol Randall 800-:54-8955 x 133 <br /> CONTRACTOR ADORESS CONTR.LICENSE# <br /> PASTWATE2HEATERCOMPANY 1260] 132NDAVENE . FASTWWI1948BC <br /> 800-454-8955 KIFKLAND,WA 98034 01/04/2010 <br /> PROPOSED USE OF BUILDING Buud�nfl M��hanica Addlqon H T SOURCE <br /> PERMIT Combinatlon Plumbin0 WORK N�eraUon ElectAc <br /> TYPE ��mollllon Sign TYPE Naw as <br /> R� elrlMalnt ther <br /> COkTRACT PRICB i�F WORK $449.00 CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION Remove/Aepluce Gas WuterHeater <br /> P��.� MECNANICAL <br /> NO TYPE QF URE OR ITEM TYPE OF IXTURE OR ITEM <br /> '___ WATER CL03ET _ A/C•A/HANDLING UNITS <br /> ____ BATHTUB _ FORCE6 AIR SYSTEMS <br /> LA,VATORY(WASH BASIN) ___ HEAT PUMP <br /> _ SHOWER � ____ UNIT HEATERS <br /> _ KITCHEN SINK& DISPO6AL _ CLO7HES DRYER <br /> _ pISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY 1 _ WATER HFATER <br /> _�_ CLOTHES WASNER __ METAL FIREPLACE/STOVE <br /> URINRL _ FIREPLACE INSERT <br /> ORINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER _,_ OAS PIPWG <br /> SINK (SERVICFJBAR/MOPlETC.) ,,, EXHAUSY FAN <br /> _�_ OTHER _ OTHER _�__r <br /> l HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APLICA710N AND KNOW THE SAME TO BE TRUE ANO CORRECT,ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED WIHT WNETHER SPECIFIED HEREI <br /> OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GN'c AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LnCAL LAW REGUTATING CONSTRUCTION ORiHE PCRFORMANCE OF CONSTRUCTION.THATIAMAUTHORIZED <br /> BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOt2 WHICHAPPLICAT70N IS MAOE AND I COMPLY WfTH THE STATE <br /> CONTRACTOF2S LAW 18.27 RCW AND 288.200 WAC. <br /> Slgnature of OwnorlCantraetor/Authorized Agant �y.��r,y���p Date OS/14@008 <br /> / Rfl am <br /> I <br /> �» <br /> �.fi� <br />