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u� L����L�IJ V l� � <br /> ;-�- R�RMIT APPLICATK_-N � � ��l FEB U 3 2005 <br /> ���� CITY OF EVERETT PERMIT SERVICES <br /> ._ 3200 CEDAR STREET, EVERETT, WA 98209, 425-ZS�-BH�1D' OF EVERETT <br /> � i � � [ > . �, / - .5� Fn�i.neerinp�Pu�If�l46Y�tes <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> J621 Vi1:1\'DR, fV1:RGTI'. WA 9R203 OOG05700000300 �n,, �., <br /> /�I 5���� `�v <br /> LEGAL LOT NO. BLOCK ITRACT <br /> DE <br /> OWNER ADDRESS PHONE <br /> uo�niaz.��aitv a�?i vu.�v oa <br /> • GVGRL•TT. WA 98203 (�1?5)252-220G <br /> TENANTNAME CONTACTNAME PHONE <br /> PAMfLA 1IILI. 4?5 R14-312d s133 <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> PAST WA'I'f:R IiI:ATI'R COMPANY 12(,01 132ND AVf NI: PAS"I'NIICOS?bP <br /> (q25)814-3124 h��tKLAND, N'A 9803d 02/IG/20D5 <br /> PROPQSED USE OF BUILDING 8����dinp �taeh�n�ca Addition HEAT SOURCE <br /> PERMIT Cornbinellon Plumbing WORK p,�taration Ele�trie <br /> n'pE Oamolilion Slyn T�'PE New ac <br /> r Re elrlMalnl her <br /> CONTRACT PRICE OF WORK $dq9,00 CITY OF EVERETT LOCAL SALES TO.X CODEIS 3105 <br /> WORK DESCRIPTION �tcmo�•c/Rcplace Gas N'atcr licmcr <br /> PIUMeING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ______ WATER CLOSET ______ A!C-A/HANDLING UNITS <br /> ____ BATHTUB ______ FORCED AIR SYSTEMS <br /> ____ LAVATORY (WASH BASIN) _____ HEAT PUMP <br /> ___ SHOWER ___ Ut:iT HEATERS <br /> ____ KITCHEN SINK 6 DISPOSAL _____ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> ___ LAUNORY TRAY __�__ WATER HEATER <br /> __ CLOTHES WASHER ____ METAL FIREPLACEISTOVE <br /> URINAL FIREPLACE INSERT <br /> T DRINKING FOUNTAIN � GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> __ BACKFLOW PREVENTER __ GAS PIPING <br /> ___ SINK (SERVICE/BARIMOPIETC.) ___ EXHAUST FAN <br /> ____ OTHER __ _�_ OTHER_______�__________ <br /> 1 HEREBY CERTIFY THAT I HAVE READ ANC 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 COMPL�ED WIHT WHETHER SPEC�FIED HEREI <br /> OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVc AUTHORITY TO VIOLATE OR CANCEI.THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TNE PERFORMANCE OF CC:JSTRUCTION.TNAT I AM AUTHORIZEO <br /> BY THE OWNER Of THIS PROPERTY TO PERFORM THE NlORK FOR WMICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> C04TRACTORS LAW 7827 RCW AND 296.200 WAC. <br /> Signalurn of OwnerlContractorlAuthorized Ageni � : 'r � Date Oi/02/2005 <br /> ui mi <br />