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,-- c�ERMiT APPLICA� _�N <br /> � ClTY OF EVERETT PERMIT SERVICES <br /> .._ 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> CK2039 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> i71A 10 DR 14', GVGRGTT. WA 98203 0083G700001300 � -� a <br /> � C -� <br /> LEGAL !OT NO. BLOCK ITRACT <br /> DE <br /> OWNER ADDRESS PHONE <br /> s�is io �aw <br /> �usia.�errasv (azs��o�-ia�s <br /> • evrRcrr, wn nszos <br /> TENANTNAME CONTACTNAME PHONE <br /> PAMGLA Ii1LL 425 RId-312A x133 <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> I'AS'I' WATGR FIGATfiR COMPANY 12G01 132ND AVG NG PAS7'WIIC052D1' <br /> (d25)814-3124 KIRKLAND, WA 9803A 02/1G/206'�f� I <br /> PROPOSED USE OF BUILDING Building Mechanica WORK Addition HEAT SOURCE �i <br /> PERMI7 Comhinaflon Plumbing Alteretfon (�Electric <br /> TypE Domolilion Slgn TYPE New as <br /> rl k� r Re atrlhlaint ther <br /> CONTRACT PRICE OF WORK �qq9,p0 CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION Remove/Replace Gas Water lieater <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ___ WATER CLOSET ______ AIC-A/HANDLING UNITS <br /> ____ BATHTUB �_____ FORCED AIR SYSTEMS <br /> ____ LAVATORY (WASH BASIN) _____ HEAT PUMP <br /> ___ SHOWER �__ UNIT HEATERS <br /> ___ KITCHEN SINK $ DISPOSAL _____ CLOTHES �RYER <br /> ___ DISHWASHER __ _ RANGE HOOD <br /> �__ LAUNDRY TRAY __�__ WF.TER HEATER <br /> ___ CLOTHES WASHER ____ METAL FIREPLACEISTOVE <br /> __ URINAL ____ FIREPLACE INSERT <br /> � DRINKING FOUNTAIN ___ GAS FIREPLACE <br /> _ FLOOR DRAIN ___ GAS RANGE <br /> BACKFLOW PREVENTER __ GAS PIPING <br /> _, SINK (SERVICE/BAR/MOPIETC.) ___ EXHAUST FAN <br /> ---- OTHER_ _�_ OTHER------------------------ <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APLICATIUN AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO WIHT WHETHER SPECIFIED HEREI <br /> OR N07.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCE�THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TNE PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED <br /> BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE I <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. I <br /> Signature of OwnerlContraetor/Authorized A eN Date �, <br /> � . _' /�% c.i" 02/Id/ZOci <br /> ui o41 I <br /> I` J <br />