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��� Sent By: HP LaeerJet 3100; 4258249516; 1.1ay-9-06 2:09Pl,1; Page 2/3 '�^� <br /> ��y�; <br /> �"; ,^T FCRMIT APPLILATIvN „§x> �� <br /> ��i�� CITY OF EVERETT PERiVIIT SERVIf�ES , � `� <br /> ���`n'�' <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 ; ,.,,�y�.,";,� <br /> 09090G � n� t �_ -:;-i <br /> ��., n�.�� .��T���e <br /> SITE ADDRE55 PARCEL TA�( I.D.# PERMIT# I , "�<�°: <br /> �;;w:��:-=;:sa 7 <br /> S16»I PL,GVERF.TI', R'A 96201 00501yUU00�1800 G�5 �/� i ; : <br /> �;;: <br /> LEGAL LOT NO. BL.00K ITRAC7 �- �;'''' <br /> E�, <br /> OWNER AODRESS PHONE <br /> GRUZA,GALH R,MA(;I.LY, STEVF S1G 41 PL <br /> • LVERE•T"i, 1t'A 98201 (42$)252-IJ94 <br /> TENANT NAME CONTACT NAME PHONE <br /> PAMELP TITLL -025 814-:t124 .�133 <br /> � <br /> CONTRACTOR ADDRESS CqNTR.LICEkSE# <br /> FAS'f WATER HL•ATF.R COMPANY 12G01 132ND AVF NG FAST14"1VIf9488C � „ n`�.s�: <br /> KIRKLAND, WA 95031 � � �""ti �-:�. •i <br /> (425)81���I'l4 01/U1/_OOR F,.,��. <br /> PROPOS£D US� OF BUILDING aundtno reecnan�ca Addltlon H T SOURCE ;�� <br /> PERMIT Combinullon �'lumelnp WORK Alloratlon Elecl�c - <br /> TYPE Pamolltlon :ilgn N�E Naw Gac � <br /> r r R� alr/Malnt Olhrtr �� � <br /> CONTRACT PRICE OF WORK $qq9.00 �CITY OF EVERETT LOCAL SALES TAX CODE15 3105 I <br /> ,;. ,, � <br /> WORK DESCRIPTION Rcmovc/Replace Gas Watcr lIcatcr � � <br /> jt-� <br /> Ll <br /> 4 -nr�--afc:LY'�if� <br /> �r - <br /> th ' �` <br /> PLUMB�G MECHANICAL <br /> 7YP OF TU E OR I7EM O. TYPE OF FIXTURE R ITE <br /> ___ WATER CLOSET _______ AIC•A/HANDLING UNITS <br /> ______ BATHTUB __�___ FORGEO AIR SYSTEMS <br /> _�., LAVATORY (WASH BASIN) �_�_ MEAT PUMP <br /> __M__ SHOWF.R ___ UNl7 MEA7ERS <br /> __,___ KITCHEN SINK 8 DISPOSAL ___,__ CLpTNES ORYER <br /> _^__ DISHWASHER _ _ RANGE H�OD <br /> ____ LAUNDRY 7RAY _1__ WATER HEATER <br /> __ CI.OTIiES WASNeR `�__ METAL �IREPLACEfSTOVE <br /> �__ URINAL ___,,_ FIREPLACE INSERT <br /> �_ ORINKING FOUNTAIN ,______ GAS FIR�PLACE <br /> ,�_ FLOOR DRAII� _� GAS F<ANGE <br /> _____ BACKFLOW PREVENTER _�, GAS PIPING <br /> i _, SINK (SERVICEfBAR/MOF/ETC.y �,___,__ EXHAUST FAN <br /> I ---- DTHERA ----- OTHER----�--------------- <br /> _�_ � _______� _. <br /> ��.-- --------------------- <br /> ' --------------------- ` ,. `,,,.. <br /> J ---- -- —^ - --�-- -- '-------------- .. .7 <br /> i <br /> 1 HEREt�Y CER;IFY THA7 I HAVE READ AND EXAMINEO THIS APLICATION tiND KNOW THE SAME TO BE 7RUE AND CORRECT ALl � ¢�`' ��� <br /> � PROVISIONS OF L�1WS AND ORDINANCES GOVERNING THIS TYPE OF WpRK WILL BE COMPLIEO WIHT WNETHER SPECIFIED HEREI � '' <br /> � pR NJT.THE GPAMTING OF A PERMIT DOES NOT PRESUME TO GtJE AUT���iORITY TO VIOLATE OR CANCEI THE PROVISION OF ANY � ^"`�'� <br /> OTHER STATE OR L(xAL lAW REGUTATING CONSTRUC7i�N OR THE PI3RFORMANCE OF CONSTRUC710N.tHAT I AM AUTHCRIZE❑ . � <br />� ;?��I BY rHE OWNER OF iH15 PROPER7Y 70 PERFORM THB WORK FOR WHICH APPLICnT10N IS MADE ANO i COMPLY WITH THE STA7E � _ -::,;���� <br /> .y CON(RACTORS LAW 1817 RCW AN� 298,2U0 WAC. *� -- �^^ <br /> Slgnuturo of UwnorlContracrorlAuthorized Aponi �,.:.,:�„ ._ , bate � <br /> i-a-i��c;`/' � US/09l2006 <br /> ul o�� <br /> .. _ " _ . . . . � '�'` r--1 <br /> �� 5 <br /> . _ . . � ��.?.-'t.. <br /> �„ <br />