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;-� � � 'ERMIT APPLiCA i �ON <br /> ��i?� ClTY OF EVERETT PERMIT SERVICES <br /> ._ 3'u�C CEDAR STREET, EVERETT, WA 98201, 425-257-8$10 <br /> 01797i <br /> SI7E ADDRESS PARCcL TAX I.D.# PERMIT# <br /> ,� <br /> �52dJACKSONAVP, uVGRLTT,AVA 98203 00545104001200 ��r� � ����_ ������' <br /> LEGAL LOT NO. BLOCK ITf2ACT <br /> DE <br /> OWNER ADDRESS PHONE <br /> 2524 JACKSON AVH <br /> PILLAR, KAREN (425)347-01IG <br /> • GV[RGT'1'. \UA 98203 <br /> TENANTNAME CONTACTNAME PHONE <br /> I'AM[LA 11ILL 425 814-3124 x 133 <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> PAS'I'WA'113R IIGATGR CONIPANY IZ(OI 1�2T�D AV8 NE PASTIV4I�052D� <br /> (42>)�14-3124 KIRKLAND, \VA 93034 02/IG/2005 <br /> PROPOSED USE OF BUILDING euildir.p Meehanica WORK Addition HEAT SOURCE <br /> PERMI7 Combinallon Plumbing Alteretion QElectric <br /> TYpE BDomolilion ❑Sign TYPE Now as <br /> S rinkl r Re aIrIM:.Int ther <br /> CONTRACT PRICE OF WORK 5349.00 CITY C�F EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION <br /> Rcmovc/Rcplacc Glcctric 1Vatcr Hcalcr <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ____ WATER CLOSET ______ A/C-A/HANDLING UNITS <br /> ______ BATHTUB �_____ FORCED AIR SYSTEMS <br /> _____ LAVATORY (WASH BASIN) _____ HEAT PUMP <br /> ______ SHOWER ___ UNIT HEATERS <br /> _____ KITCH[N SINK & DISPOSAL ____ CLOTHES ORYER <br /> ____ DISHWASHER � _ RqNGE HOOD <br /> _____ LAUNDRY TRAY __�__ WATER HEATER <br /> ____ CLOTHES WASHER ��_ ME7AL FIREPLACE/STOVE <br /> ___ URlNF�.I. ____ FIREPLACE INSERT <br /> __ DRINKING FOUNTAIN ___ GAS PIREPLACE <br /> _ F:.00R DRA1N _`_ GAS RANGE <br /> ___ BACKFLOW PREVENTER __ GAS PIPING <br /> ___ SINK (SERVICEIBAR/MOP/ETC.) ___ EXHAUST FAN <br /> _____ OTHER� �_ OTHER_____�_____�___ <br /> ---- ------��—^ <br /> � --- ------------- <br /> i HEREBY CERTIFY THAT I HAVE READ AND EW+MINEC THIS APLICATION AhlD KNOW THE SAME TO BE TRUE AND CORRECT,ALL <br /> PROVISIONS OF L�.WS AND ORDIN,4NCE5 GOVERNINu THI�TYPE OF WORK WIIL BE COMPLIED WIHT WHETHER SPECIFIED NEREI <br /> OR NOT.7HE GRANTIN(',OF A PERMIT DOES NOT PRESUME 'O GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL lAW REGULATIMG 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 THE STATE <br /> CONTRACTORS LAW 19.27 RCW AND 296.20�WAC. <br /> Signature of OwnedContracmrlAulhorized Ayeni �,_._::��_���. j-- Date 04/I I/2003 <br /> nv a�i <br />