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,-�� R�E�iVlIT APPLI�ATI� N <br /> � CITY C1F EV�RETT PERMIT SERVICES <br /> .._ 3200 C�DAR STR�ET, EVt=RFTT, WA 98201, 425-257-8810 <br /> c�:zoso <br /> SITE ADDRESS 'PARCEL TAX I.D.# PERMIT# <br /> ?51 I JACKSON AVB,GVGRETT, WA 98203 00545103902400 �/J��� �JC <br /> / <br /> LEGAL LOT Nfl. BL�CK ITRACT <br /> DE <br /> OWNER AODRESS PHONE <br /> �si i �nchsoH nvr azs z�o-ysaa <br /> MARINO. \'ALGNTING . HVGRHTT, WA 98203 � � <br /> TENANTNAME CONTACih1AME PHONE <br /> PAMGLA 1IILL 425 814-3I'!4 �133 <br /> CONTRl�CTOR AD'JRESS CONTR.LICENSE# <br /> rnsr�v.��rrt iisn��it coMi�nNv ia�oi i3zNn nve hr r•nsrwi icosanr <br /> KIRKLAND, WA 98034 02/IG'�0��5 <br /> (425)814-3124 <br /> PROPOSED USE OF BUfLQING Buildinp Mechaniea WORK Additlon HEAT SOURCE <br /> PERMIT Com6lnallon � Plumbl�g AlleraUon QElectric <br /> 7ypE Demolilion Sign TYPE New as <br /> S r r Re alrlMalnt Iher <br /> CON4RACT PRICE OF WORK $349.00 CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION Rcmove/Replace Gicctric Wster Fleater <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEHN NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET _____._ AIC-A/HANDLING UNITS <br /> BATHTU6 �.�__ FORCED AIR SYSTEMS <br /> ____ LAVATORY (WASH BASIN) _____ HEAT PUMP <br /> SHOWER ___ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _____ CLOTHES DRYER <br /> DISHWASHER __ _ RANGE HOOD <br /> LAUNDRY TRAY __�__ WATER HEATER <br /> CLOTHES WASHER ____ METAL FIREPLACE/STOV1= <br /> � URINAL _�__ FIREPLACE INSERT <br /> DRINKING FOUNTAIN ___ GAS FIREPLACE <br /> FLOOR DRAIN _�_ GAS RANGE <br /> � BACKFLOW PREVENTER __ GAS PIPING <br /> ___ SINK (SERVIC6'BARIMOPIETC.) ___ EXHAUST FAN <br /> -- — OTHER--- _�_ 07HER---------------------- <br /> 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APLICATION AN�KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS 1VPE OF WORK WILL BE COMPLIED WIHT WHETHER SPECIFIED HEREI <br /> OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORiTY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED <br /> 8Y THE OWNER OF THIS PRO�ERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COAIPLY WITH TNE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 29620D WAC. <br /> Signaturo of OwnedCantractorlAuthorizad Ageni _�� , � ;.��'� �- Date ����,����OS <br /> u�o�i <br />