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,- F��RMIT APPLICATI.�N <br />f,wi?� CITY OF EVERETT PERMIT SERVICES <br />F..., 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />018363 <br />SITE ADDRESS PARCEL TAX I.D.# PERMI7# <br />111103PLS[,G\'GIiGTT,WA 98208 00574600000600 �i'1�30(p-pp7 <br />LEGAL LOiNO. BLOCK ITRACT <br />DE <br />OWNER ADDRESS PHONE <br />GL[R, R06ERT & PLGGI' �� 110 3 PL S[ <br />� HVBRGTT, \VA 98208 (425)290-G274 <br />TENANT NAME CONTACTNAME PHONE <br />PAMflLA l{ILL 425 814-3124 xI33 <br />CONTRACTOR ADDRESS CONTR.LICENSE# <br />PAST NATGR IiEATGR COMPANY 12GOI 132ND AVG NG ppS7'WHC052D� <br />(425)8143124 KIRKLAND, NA 98034 02/16/2005 <br />PROPOSED USE OF BUILDING ew�dmp M�chanlca ndditton HEAT :;OURCE <br />PERMIT Combin�tion ' Plumbinp W�RK Altera8on Elactric <br />TypE D�molilton Slpn TYPE New as <br />° r R� ddMa�nt her <br />CONTRACT PRICE OF WORK 5349.00 CITY OF EVERETT LOCAL SAIES TAX CODEIS 3105 <br />WORK DESCRIPTION Rcmovc/Rcplacc Elcctric Na1cr Heatcr <br />UMBI ►qECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTUR OR ITEM <br />WATER CLOSET A1C•A/HANOLING UNITS <br />� BATHTUB FORCED AIR SYSTEMS <br />____ LAVATORY (WASH BASIN) _,_ HEAT PUMP <br />SHOWER UN�T HEATERS <br />_ KITCHEN SINK 8 UISPOSAL _� _ CLOTHES DRYER <br />__ DISHWASHER _ RANGE HOOD <br />___ LAUNDRYTRAY _,�__ WATFRHEATER <br />__ CLOTHES WASHER �_ METAL FIREPLACEISTOVE <br />_ URINAL ____ FIREPLACE INSERT <br />_ DRINKING FOUNTAIN _ GAS FIREPLACE <br />FLOOR DRAIN GAS RANGE <br />__ BACKFLOW PREVENTER __ GAS PIPING <br />__ SINK (SERVICE/BARIMOPlETC.) ___ EXHAUST 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 WNETHER SPECIFIED MEREI <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CAN(.EL THE PROVISION Of ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO <br />BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MhDE AND 1 COMPLY WITH TI1E STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.20� WAC. <br />SignaWro of OwnedContractodAuthorized AgeN FJ�- �Cf— Date 06/04/2003 <br />UI ��11 <br />