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From: � O1{"5I7012 10:00 d990 P.002I002 <br /> PERN'IIT A�pL.ICATION 568942 <br /> CITY OF EVERETT PERMIT SERVICES <br /> ._ 3200 CEDAR STREET, EVERETT, WA 982�1, 425-257-8810 <br /> 425-257-8857 FAX I�- $�2 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 10030 I�OLLY DRIVE tt125,EVERETT, WA 98204 ' 'V t I Z� I -b � <br /> LEGtiL LOT NO. BLOCK ITRACT <br /> D <br /> OWNER ADOREss PHONE <br /> 1oC'�o �-to11y Of• =tkl�5 <br /> ciwvez,u�.►ses ,Ev�Ce� �v A a�� (425)244-6608 <br />�� <br /> TENANT NAME CO�JTACT NAME PHOWE <br /> , lA�te. CQS��E 425-636-705'� <br /> CONTRAGTOR ADDRESS CONTR.LICENSE# <br /> PAST WATER HEATER COMPANY 12601 132ND AVE NE rAS1'W WFi948BC <br /> 425-636-70$� KIRKLAND,WA 98034 �I�.{I �tt <br /> PROPnSED USE OF BUILDENG Culldinp Meehaniea WORK Additlon HEAI' SOURCE <br /> PERMIT Combination Plumhing AlluraUon Electric <br /> Residential TypE oomouiion Slgn TYPE New as <br /> rl r Re a!rlMalnt Iher <br /> CONTRACT PRICE OF WORK ' -- CI7Y OF EVEREIT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION Remove/Rcplacc Gas Water Henter <br /> PLUMBING MECHANICAL <br /> NO. E OF FIXTU E OR 1 EM NO. TYPE OF FIXTURE OR ITEM <br /> ___ WATER CLOSET �__ AIC-AIHANDLING UNITS <br /> __ BA7HTU6 FORCED AIR SYSTEMS <br /> _� LAVATORY(WASH BASIN) _ HEA7 PUMP <br /> _ `_ SHOWER ___ UNIT HEATERS <br /> _�__ KITCHEN SINK& DISPOSAL ___ CLpTHES DRYER <br /> ____ DISHWASHER _ _ F7ANGE HOOD <br /> _ �_ LAUNDRYTRAY �__ WA7ERHFATER <br /> _�__ CLOTHES WASHER ,_ METAL FIREPLACE/STOVE <br /> URINAI. ___ FIREPLACE INSERT <br /> _�_ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DFtAIN GAS RqNGE <br /> _ BACKFLOW PREVENTER __ GAS PIPINt3 <br /> � SINK (SERVICEIBAR/MOP/E7C.) ^__ EXHAUST FAN <br /> ,_— OTHER —_____ 07HER___—_______—_—_— <br /> I HEREBYCERTIFY THAT I HtWE READ AND EXAMINED THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIOMS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WINT WHETHER SPECIFIEO HEREI <br /> OR NOT.THE ORANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL IAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED <br /> BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICHAPPLICATION IS MADE AND I COMPLY WITH iME STATE <br /> CONTRACTORS LAW 18.27 RCW AND 298.200 WAC. <br /> Stgnaturo of Ownor/GontractorlAuthorized Agont � � Date Ol/OS/2012 <br /> ui cni <br />