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; ��� PC�.�MIT APPLICATIL.J <br />CITY OF EVERETT PERN(IT SERVICES <br />,_ 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-6810 <br />CK1036 <br />SITE ADDRESS PARCEL TAX I.D.# PERMIT�F <br />2?32 MCUOUGALL AV[, HV[R[TT, WA 9R201 00439147401702 M('[+.dr�' �'l <br />/ <br />LEGAL LOT NO. BLOCK ITRACT <br />DE <br />OWNER ADDRESS PHONE <br />2232 MCllOUGALL AVG (425)259-684d <br />OROURKL=. MARY . �VI:RtiTT, �VA 9R201 <br />TENANT NAME CONTACT NAME PHONE <br />PAMELA HILL 425 R14-3124 x133 <br />CONTRACTOR ADDRESS CONTR.LICENSE* <br />PAST WATGR HGA"i[R COMPANY 12601 132ND AVL• NH PASI'WHC052Df <br />KIRKI_ANU,�YA 9R034 02lIfi2005 <br />(425)Rld•3124 � <br />PROPOSED USE OF BUILDING euua�oo M�eh�nlea Addition HEAT SOURCE <br />PERMIi Combin�tlon Plumbinp ��ORK NpraBon I�ctric <br />IYPE D�molition Slyn TYPE New as <br />� R� drlMaint her <br />CONTRACT PRICE OF WORK g349.00 CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br />WORK DESCRIPTION K������,c/Rcplacc I:Icetric \Va�cr Hca er <br />NLUM I M�CHANICAL <br />. B NG TYP OF FIXTURE R ITEM NO. TYP OF FIXiUR OR ITEM <br />WATER CLOSET ______ AIC-AIHANDLING UNITS <br />BATHTUB _,�_ FORCED AIR SYSTEMS <br />LAVATORY (1MASH BASIN) _�_ HEAT PUMP <br />SHOWER ___ UNIT HEATERS <br />KITCHEN SINK 8 DISPOSAL __�_ CLOTHES DRYER <br />DISHWASHER __ _ RANGE HOOD <br />LAUNORY TRAY __� __ WATER HEATER <br />CLOTH�S WASHER __ METAL FIREPLACE/STOVE <br />A URINAL ____ FIREPLACE INSERT <br />DRINKING FOUNTAIN ___ GAS FIREPLACE <br />FLOOR DRAIN _�. GAS RANGE <br />BACKFIOW PREVENTER __ GAS PIPING <br />� SINK (SERVICEIBARIMOPlETC.) ___ EXHAUST FAN <br />^ OTHER_ ___ OTHER______,______�_— <br />1 HEREBY CERTIFY THAT I HAVE READ AND EW+MINED THIS APIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIGD WIHT WHETHER SPECIF�EO MEREI <br />OR NOT. TME GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTMER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED <br />BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STA7E <br />CONTRACTORS LAW 16.27 RCW AND 296.200 WAC. <br />Signature of OwnedContractorlAuthorized Ageni r�-, -�� ��� �_y- Date �,13���04 <br />