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Frun: 02/01/2010 09:49 fl549 P. �02/003 <br /> PEFZMIT APPLICATit�N 4"$93 <br /> ��;� CITY O� EVEF�ETT PERMIT SERV{CES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 , 425-257-8810 <br /> 425-257-8857 FAX <br /> 51TE ALIDRESS PARCEL TAX I.D.# PE-RMIT# <br /> s�o� io lla s�, r_vr:��•rr,wn �szos ooso�30000�aou iV1 �DO� . � / <br /> LEGAL LOT NO. BLOCK ITl2ACT <br /> DE <br /> OWNER ADDRESS PHOkE <br /> MBNSTrLL,STLPI3BN 8��9 10 DR SE � <br /> • EVEF2ETT, �VA 98208 (4-5)355-S28R <br /> TENANT NAME CONTACT NAME PHONE <br /> Carol Randall 425-636-7054 <br /> CONTRACTOR ADDRESS COUTR.LICENSE# <br /> PASTWATBRI�IGA'I'ERCOMI'ANY 12G01132NDAVENE FASTIV1VElIa8[3C <br /> 425-636-7054 KIRICLAND, WA 98034 p���; ��7� <br /> PROPOSED USE OF BUILDING ewmtnp Machanlcal WORK Additfon HEAT SOURCE <br /> PERMIT ' Combioallon a�?IumCInB qltaratlon QEIaeMe <br /> Residential TMpE oumolltlon Sign TYPE Now as <br /> > r Re elrlMalnl Ihe, <br /> CONTRACT PRICE Or WORK 5449.00 �CI�• �F EVEREIT LOCAL SAl.ES "iAX COD�';. 3103 � <br /> WORK DESCRIPTIDN Remove/Replocc Gas Motcr Ilcatcr ! <br /> pLU1dBING MECHANICAL <br /> NJ. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ____ WATER CLOSET _�___ A/C-A/HANDLING UNITS <br /> _^_ BATHTUB _�__ FORCED AIR SY57EMS <br /> ____ LAVATORY (WASH BASIN) _ HEAT pUMP <br /> _____ SHOWER UNIT HEATERS <br /> __—___ KITCHEN SINK & OISPUSAL ____ CLOTHES DRl'ER <br /> ___ DISHWASHER _ RAtJGE HOOD <br /> ___ LAUNDRY TRAY __ 1 _ WATER HEA7ER <br /> ____ CLOTHES WASHER __ METAL FIREPLACE/STOVE <br /> ____ URINAL _�_ FIREPLACE INSERT <br /> ___ DRINKING FOUNTAI�J _ GAS FIREPLACE <br /> ___ FLOOR pRAIN _ GAS RANGE <br /> ___ BACKFLOW PREVENTER ___ GAS PIPING <br /> __ SINK (SERVICEJDAR/MOP/ETC.) ___ EXHAUST FAN <br /> __ DTHER _A_ 07HER___.___,_____ <br /> t HERE9Y.GERTIFY THA71 FiAVE READ AND EXAMINED THIS APtICA170N AND K�10W THE SAME TO BE TRUE AND CORRECT,qi.L <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK Wlll BE COMPLIED WIHT WHETHER 5PECIFIED HEREI <br /> OR N07.THE GRANTING OF A PERMIT DOE5 NOT PRESUME 'O GIVE AUTHORITY?O VIOLATE OR CANCEL 7HE PROVISION UF ANY <br /> OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.THAT I AM AU7HORIZED <br /> BY THE OWNER OF TNIS PROPERTY TO PERFORM THE W07.lC FUR WHICH APPLICATION IS MAOE AND 1 COMPLY WITH TNE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> Si�natura of OwnadContractor/F.athoriznd Aflant �,�����,��p Date 03/Ol/2010 - <br /> asi ca� <br />