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Fram: 17 /07/��11 13:07 ?181 P.003/004 <br /> ----� <br /> PERI'JIIT APPLICATION 56,64, <br /> �;i�� ClTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> 425-257-8857 FN: �� ��]��� <br /> SITE ADDRESS PARCEL TAX I.D.# PER411T# <br /> 1315 KOSSUTH AVE,EVERETT, WA 98203 00394100100900 <br /> � — � � <br /> LEGAL LOT NO. BLOCK TRACT <br /> D <br /> OWNER ADDRESS PHONE <br /> GARRLTT,ROBIN 11437 82 PL S (206)790-8611 <br /> • SL•ATTLB, WA 98178 <br /> TENANTNAME CONTACTNAM PHONE <br /> ulie aS�ti azs�ssao� <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> PAST WATER IiBAT6R COMPANY 12601 132ND AVE NG FASI'N'WH9A86C <br /> K]RKLAND, WA 98034 01/042012 <br /> 425�36-70$+� <br /> PROPOSED USE OF BUILDING au�minp Mar.h�nlca WORK �+ddltton H T SOURCE <br /> PERMIT Comhinalion VlumCing Alteratlon Elactric <br /> Residential 7ypE Demolition Sign n'PE Naw as <br /> rl r Re aIrlMalnl (her <br /> CONTRACT PRICE OF WORK i � � ,—" CITY OF EVERETT LOCAL SALES TAX CODEIS 310.5 <br /> WORK DESCRIPTION Remove/Rcplacc L'Icctric Water Heatcr <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �__ WATER CLOSET ,___ AIC-AIHANDLING UNI7S <br /> __ BATHTUB _�__ FORCED AIR SYSTEMS <br /> _�_ LAVATORY (WASH BASIN) _ 11EAT 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 FIREPLACElSTQVE <br /> � URINAL ____ F�REPLACE INSERT <br /> DR�NKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER __ GAS PIPING <br /> __ SINK (SERVICEIBAR/MOP/ETC.) ___ EXHAUS7 FAN <br /> ____ OTHER _�_ OTHER___^___________ <br /> 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WIHT WHETHER SPECtFIED HEREI <br /> OR NOT.TME GRANTING OF A PERMIT DOES NOT PRESUME TO GNE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULl�TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.THnT I AM AUTI�ORIZED <br /> BY THE OWN[R OF Tl115 PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 298200 WAC. <br /> Signaturu of Owner/Contrector/Authorized Agent Date ���07/2011 <br /> u� vi� <br />