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From: <br />01/1F/2009 10:34 q808 P.002/OU3 <br />�,.�- PER�rIIIT APPLICATION <br />CITY OF EVERETT PERNfIT SERVICES <br />�, 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />_ _�,_ . _ 425-257-8857 FAX <br />SITE ADDRESS PARCEL TAX I.D.# �(�� PERMIT; <br />131 i 55 ST SN', EVBftE'f7', ��A J8203 OOS47000002400 ��/' U� v I <br />OWNER <br />LIB13HA2T, lUA4DERLY <br />TENANT <br />ADDRESS <br />122 HAMLE'f DR <br />KING OP PRU ;51A, PA 19406 <br />CONTACT NAME <br />Carol Randall <br />CONTRACTOR ADDRESS <br />FA3T \VATER I-ILATCR GJMI'ANY 1260] 132ND AVE NE <br />KIRKLAND, WA 98034 <br />p q25-636-7054 <br />PROPOSED USE OF BIJILDiNG ewminp Machanlca WORI <br />PERMIT Combinetion Plumbinp <br />TypE oomolilion slpn TYPE <br />PRICE <br />S449.00 <br />WORKDESChiPTION Rcmovc/RepinccGas\Vnier]Ieatcr <br />� BATHTUB <br />__Y__ LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 3 DISPOSA� <br />DISHWASHEk <br />� LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />^ DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />___ SINK (SEe�VICE/BAR/MOPIETC.) <br />_____ OTHER _ ,_ <br />New <br />PHONE <br />429�69 <br />V � <br />(206)718-3270 <br />425-636-7054 <br />CONTR.LICENSE# <br />I� A 5'f W W H948BC <br />01/04/2010 <br />SOURCE <br />3105 <br />_______ A/GA/HANDLING UNITS -��" <br />____ _ _ FORCEO AIR SYSTEMS <br />`�_ HEAT PUMP <br />_____ UNIT HEATERS <br />_____ CLOTHES DRYER <br />__ _ RANGE HOOD <br />I WATER HEATER <br />METAL FIREPLACElSTOVE <br />_` FIREPLACE INSERT <br />___ OAS FIREPLACE <br />___ GAS RANGE <br />__ GAS PIPING <br />___ EXHAUST FAN <br />---- OTHER__------------------- <br />HEREBY CERTIFY THAT i MAVE READ ANO E%AMINED THIS APLICATION AND KNOW THE SAME TO BE TRUH AND CORRECT. ALL <br />'ROVISIONS OF LAWS AN� ORDIIJANCES GOVLRNING THIS TYPE OF WORK WILL BE COMPLIED WIHT WHETtfER SPECIFIED HERE <br />)R NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTtiORITV TO VIPLAT[ OR CANCEL THE PROVISION OF ANY <br />)THe'R STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AA: AUTHORIZEO <br />iY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FO{2 WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />:ONTRACTORS lAW 18.27 FtCW AND 296,200 WAC. <br />of OwnedContraetor/Authorizod Agent <br />�dF<a�cSQP <br />Date ��/16/2009 <br />oi .rs� <br />