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rrcn : 07/i5/2011 12: 17 n945 P.002/002 <br /> PERMIT APPLICATION 5498Q� <br /> � CITY OF EVERETT PERMIT SERVICES <br /> "y 32�0 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> a25-257-8857 FAX <br /> SITE ADDRESS PARCG!TAX I.D.# PERMI7# <br /> G030 KIiNN'OOD Dli Y,li, 1:Vliltl:'1'I', 1VA 98203 OOG21600201300 <br /> �M I I �7 - os� <br /> LEGAL LOT NO. BLOCK ITRACT <br /> _DE�C_ <br /> OWNER /lDDRES`}S /� -{�-- PHONE <br /> � R1AR'1'IN, 1-IOLI_l' ��'�� I\���1�C�� /JrT� � (.i25)3Uli-1593 <br /> • L.v���r,-ll- lvA ����0:3 <br /> ' TE�ANTNAME CONiACTNAM� PHONE <br /> 'fl,(�I r'- C�'l� --��_ 425-636-70$ <br /> �ONTRAC70R ADDRESS CONTR.LICENSE# <br /> PAST\4'A'17;N I II:A'1'GR COTIPANY 13G01 132ND AVG NE <br /> PAS"PN�4'Il9�ifi13C <br /> PHONE �25-636-70� hlliKI.AND, \VA 98034 pl/04/2012 <br /> PROPOSED USE OF BUILDING �wmina �tochanlca pdd�Non HEAT SOURCE <br /> PERMIT Combination ' plumbing WORK , q��oraGon . Elecldc <br /> Resdential TypE Damoli�ton Sign TMPE Nvw as <br /> 5 r I r Ro alrlMalnl Ihor <br /> CQNTRqCT PRICE OF WORK � �S�-'�G�,— CITY OF EVERETT LOCAL SALES 7AX CODEIS 3105 <br /> WORK DESCRIPTION Rcmovc/Replacc I:Icctric �4'atcr llc,ncr <br /> PLUMBING MECHANICpL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ______ WA7ER CLOSET _______ NC-AIHANDLING UNITS <br /> ______ BATHTUB _____ FORCED AIR SYSTEMS <br /> ______ LAVATORY (WASH BASIN) _______ HEAT PUMP <br /> _______ SIIOWER ____ UNIT HEATERS <br /> _____ KITCHEN SINK 6 DISP(iSAL ______ CLOTHES GRYER <br /> _ _�__ DISHWASHER __ _ RANGE HOOD <br /> ________ LAUNDRY TRAY ___I__ WATEft HEATER <br /> _�__ CL07HES WASHER _ METAL FIRFiPLACE/STOVE <br /> ____ URINAL ___ FIREPLACe INSERT <br /> _�__ DRINKiNG FOUNTAIN _ GAS FIREPLACE <br /> ___ FLOOR DRAIN GAS RANGE <br />� ______ BACKfLOW PREVENTER ___ GAS PIPING <br /> ______ SINK (SERVICE/BAR,'MOP/ETC.) ___ EXKAUST FAN <br /> � ----- OTHERA-- ------ O7HER--------------------- <br /> ---- ------------------- <br /> � ----- — ------------- <br /> 1 HERE�Y C[RTIFY TVIAT I I�AVE RFAU AND EXAMINED THIS APLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AiJU ORDINANCES GOVERNING THIS TYPF OF WORK WILL BE CbMPL!ED WIHT WHETN[R SPEGFIED HEREI <br /> OR N07.T11E GRANTING OF A PGRAIIT DOES NOT f'RESUME TQ GIV[AUTHUR�TY TO VICLATE OR CANCEI TtiE PROVISION Of ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR TNE PERFORAWNGE OF CONSTRUCTION.THAT I AM AUTFIORIZEO <br /> Gv TI1E OWN[R OF 7f115 PROPERTY TO PERFORM THE WORK FOR WHlCH APPLI�ATION IS h1ADE AND I CUMPLY WITM TNE STATE <br /> �ONTRACTORS LAW 1827 RCW ANU 29fi200 WAC. <br /> �Signature of OwnedContractoNAuthorizod Agont �ato <br /> I tit�Zd l� �, o�n_srzoi i <br /> ' � �, o:� <br />