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;- ��RMIT AP�LI��iT1' lN <br /> �� CITY OF EVERET7 PEi2MfT S�RVlCES <br /> C�' <br /> `�`� 3200 CEDAR STREET, EVERETT, WA 98201, �425-257-8810 <br /> cxiexi <br /> SITE ADDR[3S PARCEL TAX I.D.# PERMIT# <br /> I0030HOLI.YDR#133, EVERBTT,WA 98204 00858501313300 �OSG(—Q��I <br /> LEGAL LOT NO. BLOCK ITRACT <br /> DE <br /> OWNER ADDRESS PHONE <br /> 100301IOLLY UR 1J133 <br /> THOMAN,RICHARD . EVGRGTT, WA 98204 (4'S)2C7-972G <br /> TESJANT NAME CONTACT NAME PHONE <br /> PAMELA HfLL 425 814-3124 x133 <br /> CONTRACTOR ADDRESS CONTR.LICCNSE# <br /> PAST NAT6R HEATER COMPANY 12G01 132ND AVC NE �AS"1'NHC052DP <br /> (425)814-3124 KIRKLAND,WA 98034 02/IG/2005 <br /> PROPOSED USE OF BUILDING Bulidinp ntacnani�ca WORK Addition HEaA7 SOURCE <br /> PERiUlT Combina0on Piumhln Alturation Electrie <br /> 7ypE Damolilion Sign TYPE Nnw as <br /> S r kler Re airlMaint Iher <br /> CONTRACT PitICE OF WORK $449.00 CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION 2emove/Replace Gas 1Vater lieater <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ______ WATER CLOSET ______ AIC-AIHANDLING UNITS <br /> ____ BATHTUB _�__ FORCED AIR SYSTEMS <br /> ___ LAVATORY ,'WASH BASIN) __�_ HEAT PUTAP <br /> � SHOWER ___ UNIT HEATERS <br /> ___ KITCHEN SINK & DISPOSAL ____ ClOTHES DRYER <br /> ___ DISHWASHER _ _ RANGE HOOD <br /> ___ LAUNDRY TRAY _�__ WATER HEATER <br /> __ CLOTHES WASHER `__ METAL FIREPLACElSTOVE <br /> , URINAL ____ FIREPLACE INSERT <br /> ____ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> � FLOOR DRA1N _ GAS RANGE <br /> ___ BACKFLOW PREVENTER __ GAS PIPING <br /> _� SINK (SERVICEIBARIMOPIETC.) ___ EXHAUST FAN <br /> ^___ OTHER ___ OTHER______________�___ <br /> 1 HEREBY CERTIFY THAT I HAVE READ AND EXAM�NED THIS 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 VIOi_ATE OR CANCEL THE PROVISION OF ANY <br /> O7tIER STATE OR LOCAL IAW REGULATING CONSTRUCTION OR THE PERFORMo.'rVE OF CONSTRUCTION.THAT I AM AUTHORIZED <br /> BY THt OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH!,?PLICATION IS MA�E AND I COMPLY WITH THE S7ATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> Signature of OwnedContractodAuthorized Ageni �.:--��- ,��'�_ �- Date 0�@G/2005 <br /> ui a�i <br /> .�^.--..-_.. <br />