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� � <br /> JUIJ-11-2a11 15:SB From:4258149516 Paae:2�3 `,' <br /> i <br /> �'ERMIT AI�PLiCA`TION 54499� [, <br /> � CITY OF EVER�ETT PERMIT SERVICES <br /> �. 3200 CEDAR STREET, EVERETT, WA 98201, 42a-257-881Q R!� <br /> 425-257-8857 F'AX 6�l 3''� t" <br /> SITE ADDRESS PARCEL 7AX I.D.# PERMIT# <br /> 523 47 S7'SE,EVGRETT,�VA 98?.03 29053100306700 4,� /I Q / " o✓�� ��, <br /> VI (L <br /> LEGAL LpT NO. BLOCK I7f2ACT <br /> bE � <br /> OWNER ADDRESS PHONE � <br /> JONES,ROSINA�C[�ILL <br /> 528 47 ST SE (qZ5)339-9339 i <br /> • EVERETT,WA 98203 , c <br /> TENAN7NAME CONTACTNAME PHONE `` <br /> � �L�l� QSk-e. 425-636-70$� <br /> CONTRACTOR ADDRESS CONTR.I.ICENSE# <br /> FA57 WATER HEr1T6R COMPANY 12601 132NJ AVE NG <br /> FAST\V�VH94SBC <br /> 425$36-70� ��-AND, N'A 98034 01/04/2012 <br /> PROPOSED USE OF BUILDING o��iaiaq Me�n�mca aad�uon HEAT SOURCE <br /> PERMIT Combination PIum6ing WORK , q��eration �Eloctric <br /> Residential 7'ypE Domoliuon SIBn NPE Now as <br /> S ler Re etr/Maint lher <br /> CONTRAC7 PRICE OF WORK ��5 �' CIiY OF EyERET7 LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION Remove/Replace Gas Water Hearer <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM ND. TYPE OF FIX7UFtE OR ITEM <br /> ____ WATER CLOSET __�__ A/C-AIHANOLING UN17S <br /> __ BATH7UB ��_ FORCE� AIR SYSTEfdS <br /> ___�__ L4VATORY (WASH 6ASIN) _� HEAT PUMP <br /> ___ SHOWER _�_ UNIT HEATFRS , <br /> ____ KITCHEN SINK 6 OISPOSAL �___ CLOTHBS i;P.'i4-%; i � <br /> _.`_ DISHWASHER RANGE NODU ; <br /> ,___ IAUNDRYTRAY �1__ WATERHFIITER € ., <br /> ^__ CLOTHES WqSNER _� METAL FIREPLACElS?�*'e <br /> _�_ URINAL _ _ FIREPLACE IN�ER7 <br /> _____ DRINKIN� FOUNTAIN GAS FIREPUlCE � <br /> __ FLOUR DRAIN GAS RANGE <br /> ___ BACKFLOW PREVENTER GAS PIPING <br />�' _�_ SINK (SERYICEJBAR/MOP/E7C.) __ FJ(HAUST FAN <br /> ___ OTHER _ OTHER_�_` __,____ <br /> I HERE6Y CERTIFY THqT I NAVE READ AND EXAMINED THIS APLICATION AND KNOW 7HE SAME TO BE TRUF AND CORRECT,AlL T <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING 7HI5 TYpE OF VJCRK WILL BE COMPLIEO WINT WHE•THER SFECIFIED HEREI <br /> OR NOL 7HE GRANTING OF A PERMIT DOES NU7 PRESUME TO GNE AUTHORITY TO VIOLATE OR CANGEL 7HE PROVISION OF ANY <br /> OTHER STATE OR LOCAI,LAW REGULA7ING CONSTRUC710N OR THE PERFORMANCE OF CONSTRLJCTION.THq71 AM/1UTHORIZ[� <br /> eY THE OWNER OF 7HIS PROPERIY TO PERFORM TT1E WORK FOR WHICH APPLICA710N IS MAOE ANU I CfJtr1PLY Wi7H 7NE SiA7E <br /> CONTRACTORS LAW 1�.27 RCW qN�29fi.20D WAC. <br /> Signature of OwnuNContraclorlAuthofized Ag¢nt ' ' ' � Date <br /> 06/I0/2011 <br /> tf�?ni <br />