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Sent By: HP LaserJet 3100; _ � 4250249516; Feb-2'. �Ofi 10:27AM; Page 2 <br /> REkMIT APPLICATION <br /> ���� CITY OF EVERETT pERIVI�T SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-881U <br /> uzzior� <br /> SITE ADDRE99 PARCEL TAX I.D.* PERMITM <br /> 5515 I DR W,�;VERF.Ti',WA 9A203 OU81660000:900 <br /> LEGAL LOT O. rn�CDO°Z—�°1S <br /> BL�K ITRACT <br /> OWNER ADDRESS PNONE <br /> J,ICHEC,A7AI.GOR"LATA 5515 I DR W <br /> • EVERE'IT, WA 98:U3 (4Z5)353-31@2 <br /> TENANTNAME CONTACTNAME PHONE <br /> PAMELA NILL 425 814-3124 x13J <br /> CONTRACTOR ADDRESS CONTR.LlCENSEN <br /> 1'ASI N'ATERHEATEkCUb7PANl' I2601132NDAVENF. <br /> FASI'N'W H9J9 RC <br /> (425)814-31:i KIRKLANp,Wp 98034 U1/03R008 <br /> PROPOSED USE OR 6UILDING ���d�^o M roA�Mcs neol�lon T SOURCE <br /> PEF.MIT Canylmtlan PI�mDinp W0� Ndntlon Mclria <br /> IYPL WmWlllon D�qn IYPE N� ac <br /> CONfRACT PRICE OF WORK ���"� <br /> E449.00 C�TY Of EVERETT LOCAL bALES TAX CODEIS 3�05 <br /> WORK DESCRIPTION gemuvclRcplace Gas Water Hwter <br /> ��� C16CNANICAL <br /> I URE OR ITEM TYpE QF <br /> ______ WATER CLOSET AIC•A/FiANDLINO UNI7S <br /> ___�_ BATHTU6 � FORCED AIR SYSTEMS <br /> _____ LAVATORY(WASH BASIN) � � HEAT pUMP <br /> _ SHOW[R � UNIT NEATERS <br /> __ _ KITCNEN SiNK 6 DISPOSAL � CLOTHES DRY�R <br /> ____ DISHWASHER RANGE HOOD <br /> __�__ LAUNORY TRAY � I WATER HEIITER <br /> _�__ CLOTHES WASHER MiTAL fIREPLAGElSTOVE <br /> T_ URINAL � FIREP1,qCE INSERT <br /> _. _ ORINKING FOUNTAIN � GAS FIREPLACE <br /> _ FLooR DRAIN oA� RANO! <br /> —____ BACKFLOW PREVENTER _� (iA5 PIPIN6 <br /> SINK (SERYICElBAWA{OPIETCJ � EXHAUST FAN <br /> --- OTNER��_ �_ _,�_ OTHER------------__. <br /> I HEREBY CERTIFY THqT i t!AVE READ AND E%AMINEO THI8APLICATIONANC KNOw 7HE SAME TO BE TRUE AND CURRECT,Al: <br /> PROVISIONS OF LAWS AND OhlDINANCBS GOVERNIMu TH15 TYPE Of WORN WILI BE COMPLIED WIHT WMETHER SPECtFIED MERei <br /> OR NOT.TNE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE AUTMO:iIN TO VIOIATE OR CnNCEI TME PROVISION OF ANY <br /> OTHER STATE OR LACAI.LqW REGUUTING CONSTRUC710N OR TME PERFCRMANCE OF CON57RUCTION.h1AT1AMAUTHORIZED <br /> 9Y 7ME OWNER OF tH15 PROPERTY TO PERFORM TNE WORK FOR WHICN�PPIICATION IS MAOc ANO I COMPLY WRH TFIE STATE <br /> CONTRACTORS LAW 18.27 RCW ANO 288.200 WAC. <br /> signeWra of QwnedConwetorlAuthori:�d Apam �,.:,.r^_�. ,�__-- D�ta <br /> _%'. . OZ21,20W <br /> �N N� <br />