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From <br />09126��011 09:55 k697 P.002/003 <br />PERMIT APPLICATION <br />��i��CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />425-257-8857 FAX <br />SITE ADDRESS <br />5127 W HIGIILAND FLD, EVGRETT. WA 98203 <br />OWNER <br />KIN'LEL,CHARLES <br />CONTRACTOR <br />I'AST WATER fiEATER COMPANY <br />ADDRESS <br />St27 W HIGHLAND RD <br />• GVBRLTI'. WA 98203 <br />12601 132ND AVE NG <br />K1RkLANU, WA 9803R <br />PROPOSED USE OF BUILDING � nwiom <br />PERMIT Comblr <br />Residentiai T1fPE �•mon <br />CONTRACT PR�CE OF WORK ! <br />WORK DESCRIPTION Remove/Replacc Gas Water Heater <br />___ BATHTUB <br />�___ LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 OISPOSAL <br />M DISHWASHER <br />�� LAUNDRY TRAY <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />` _ SINK (SERVICFJBARJMOP/ETC.) <br />OTHER <br />Plumbinp ••vn� <br />Siyn T7PE <br />EVERETT <br />� <br />556752 <br />�a�� <br />PERMIT# <br />(425�118-5820 <br />CONTR.LICENSEA� <br />PAST W W H948BC <br />ovoano�z <br />SALES TAX CODEIS 3105 <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRVER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS ftANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTH ER____--___—�._�_,._ <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APLICATION AN� KNOW THE SAME TO BE TRUE AND CORREC7. ALl <br />�ROVISIONS OF LAWS AND OROINANCES GOVERNING 7HI5 TYPE OF WORK WILL 8E COMPLIEO WIHT WHE"fHER SPECIFIED HERE <br />)R NOT. TME ORANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIpLATE OR CANCEL THE PROVISION OF ANY <br />)THER STA7E OR LOCAL lAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT IAM AUTHORIZEO <br />IY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATON IS MADE AND 1 COMPLY WITH TME STATE <br />:ONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />Siynature of OwneNCantraclorlAuthorizetl Agent <br />Date 09262011 <br />ui vi� <br />