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From: 12I��i2010 08:32 �302 P.003/005 ; <br /> ' �. i <br /> 517735 � <br /> PERMIT APP�ICATION <br /> ��i� C�TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> 425-257-8857 FAX <br /> SITE AaDRESS PARCEL TAX I.D.# PERMIT# <br /> 2920 V IC7'OR PL.,EVERI:TT,WA 96201 00553100600900 n,.� I O '2_ � /' <br /> "M i <br /> LEGAL LOT NO. BLOCK TRACT <br /> OWNER ADDRESS PHONE <br /> IiOLTE,JONATHAN DOES NOT HAVG EMAfL (.725)259-6795 <br /> TENANT NAME CONTE►CT NAME PHONE <br /> Carol Randall q25-636-7054 i <br /> CONTRACTOR ADDRESS CONTR.LICENSE* <br /> FAS'1'WATERHGATBRCOMPANY 12G01132NDAVI3NG F.4STWWH948BC <br /> KIKKLAND,WA 98034 01/04l1012 <br /> 425-636-7054 <br /> PROPOSED USE OF BUILDING eulm�np M�ch�nlcs WORK AddlGon H T SOURCE <br /> PBRMIT Comhln�Hon Plumtino �u�Katlon ENeMe <br /> Residential TMpE D�mdi4on Slpn NPE N�w Gaa <br /> ry a. drlMalnl u�.r <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODEIS 9105 <br /> WORK DESCRIPTION aemo�•cAtcplucc Gas Watcr Ilcatcr <br /> P W M BIN(3 MECHAN ICAL <br /> F U ITE OF U R TE <br /> __ WATER CLOSET _�_ NC-A/HANDLINO UNITS <br /> __ BATH7UB _�� FORCED AIR SYSTEMS <br /> _� LAVATORY (VIlASH BASIN) NEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 6 DISPOSAL CLOTHES DRVER <br /> DISHWASHER _ _ RANGE HOOD <br /> _ LAUNDRY TRAY 1 _ WATER HEATER <br /> __ CLOTHES WASHER ___ METAL FIREPLACEfSTOVE <br /> URINAL _�_ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ OA8 FIREPUICE <br /> FIOOR DRAIN GAS RAN6E <br /> BACKFI.OW PREVENTER (3AS PIPING <br /> _ SINK (SERY��uBAR/MOP/ETC.) ___ EXHAUST FAN <br /> OTHER _�_ OTHER__ �__�_ <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT,ALL <br /> PROVISIONS OF LAWSl.ND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WIHT WHETHER SPECIFIED 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 UW REGULATIN(i CONSTRUCTION OR 7HE PERFORMANCE OF CONSTRUCTION.THAT I AM AUTMOFiIZED <br /> BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 CAMPLY WITH TME STATE <br /> CONTFiACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> Signatura of OwnerlContnetorlAuthoriz�d Apenl �y��J�,,,,�,�Qp ���� �2/03rz010 <br /> tfl_Vll <br />