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Fron: 05/22/20U8 14:00 A563 P.002/002 <br /> PERMIT APPLIGATION 4°46„ <br /> ��i� CITY GF EVERETT PERMIT ��RVI�ES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 5_a 3�g <br /> 425-257-8857 FAX <br /> SITE ADDRESS PARCEL TAX I.D.�€ PERMIT# <br /> 1312 KOSSUTH AVE,EVEItETT, WA 9B203 00394100200800 �,�o�0 5-035 <br /> LEGAL LOT NO. SLOCK lTRACT <br /> E I <br /> OWNER ADDRESS P��ONE <br /> LARnIL,DOUGI.AS R RUS�9ARIG 1312 KOSSUTH AVE (425)353-9719 <br /> • EVEREIT, WA 98203 <br /> TENANTNAME CONTACTNAME PHONE <br /> PAST INSTALLED OLD TANK Carol Randall 800-454-8955 x 133 <br /> CONTRACTOR ADDRESS CON'iR.LICENSE# <br /> FAST WATGR HEATGR COMPANY 12G01 I32ND AVE NE FASTI4�VH94SIIC <br /> KIItKLAND,WA 98034 OI/04/2010 <br /> 800-454-8955 <br /> PROPOSED USE OF BUILDING eu��emp Moehanlca Addlllo� HE T SOURCE <br /> PERAt1T Comhlnallon Plumbinp W�RK AltoraGon �E�ectric <br /> 'n'pE Oemolitian Sign T�PE New as <br /> r Re alrlM1lalnt fber <br /> CONTRACT PRICE OF WORK $449.00 CITY OF EVERETT LOCAL SALES TAl(CO�EIS 3105 <br /> WORK pESCRIP710N Remove/Iteplace Gas Water Heatcr <br /> PLUMBING MECHANICAL <br /> N . TYPE OF FIXTURE OR ITEM NO TYPE OF FIXTURE OR ITEM <br /> ,_ WATER CLOSET _____ A/C-A/HANDLING UNITS <br /> �_„ BATHTU6 ____ FORCED AIR SYSTEMS <br /> ___ LAVATORY(WASH BASIN) ___ HEAT PUMP <br /> � SHOWER __ UNIT HEATERS <br /> ,___ KITCHEN SINK & DISPOSAL ^__ CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _� LAUNDRY TRAY 1� WATER HEATER <br /> __ CLOTHES WASHER _�_ METAL FIREPLACEISTOYE <br /> _ URINAI. ___ FIREPLACE INSERT <br /> __ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> ___ BACKFLOW PREVENTER _� 6A5 PIPIN6 <br /> __ SINK (SERViCE/BAR/MOPIETC.) ___ EXHAUST FAN <br /> _ OTHER __ _ 07HER__ ,______,_ <br /> 1 HEREBY CERTI�Y THAT 1 HAVE READ AND EXAM�NED THIS APLICATION AND KNOW THE SAMt TO BE TRUE AND COFiRECT,ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVP6 OF WORK WILI 6E COMPLIEO WIHT WHETHER SPECIFIED HEREI <br /> OR NOl'.ThiE GRANTING OF A PERMI�i pOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAN'REGULATING CONSfRUCTION OR THE PERFORMANCE OF CONSTRUCTION.TH/1T 1 AM AUTHORIZED <br /> BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATIOt�IS MADE ANO I COMPLY WITH THE 57ATE <br /> CONTRAC70R5 LAW 18.27 RCW AND 296.200 WAC. <br /> Slgnaluro of Owner/ContractodAuthorizud Agnnt �,_,������,,,�.(a�p Date OS/21lZ008 <br /> r�i oni <br />