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Sent By: HP LaserJet 3100; 4258249516; Jun-12-06 3:48P1.1; Page 3/3 <br /> ;--�� PEkMIT APPLI�ATIOtv <br /> c�iw� ClTY QF EVERETT PERIV�IT SERVIGES <br /> 3200 CEDAR STREET, EVERETT, 4VA 98201 , 425-257-8810 <br /> U6120G <br /> SITE ADDRESS PAR�EL TAX I.D.# PERMIT# <br /> ssis t� ave w,r.ve�rr, wn �a2o:, oos�b�000u�_oo �� �D(a - 3.Z <br /> LEGAL LOT NO. BLOCK TRACT � <br /> DE <br /> OWNER ADDRESS PHONE <br /> PLORGNDO, JOCtiI.Y\ � PF.RDIN.4 161'L IIUT.CiRUOK AVL � S <br /> • F.vtRCT'P. \4A 95:0:� 142i 3.G-737i <br /> TENANT NAME CONTACT kAME PHONE <br /> ALLL•N, LISA FA�fF.I.A HILI. q25 N14-3124 s133 <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> fA3T\V.47'EF HGA'fF.R COMVANY 12fi01 13?Nll AVF.NL FAti'I'\VWI19J8UC <br /> i425)814-312d 1CIRKLAND, VJA 9S03J OI;Ut 2003 <br /> PROPOSED USE OF BUI�DING 6ulldinp M��chani�eu WORK Addlllon f�EAT SOURCE <br /> PERMIT ComhlnnQon Pl�mhln . .41toroUon Elenrlc <br /> TYPE Oumolllion Si.,� TYPE ��ew as <br /> I r Re atrRAnint �ber <br /> CONTRACT PRiCE OF WORK $44y,O0 CITY oF EVERETT LOCAL SALES 7A?C GODEIS 9105 <br /> WORK DESCRIP7IGN Remove/Feplace(7as \Vater Hcnter <br /> p�UMBIHG �AECHANICAL <br /> NO. TYP OF FIXTUR OR 17EM rl . TYP OF FIXTURE OR ITEM <br /> ______ WATER CLOSt7 ,______ AlG-AIHANDLING UNITS <br /> _____ BATHTUB .______ FORCED AIR SYSTEMS <br /> ____ LAVATORY (WASH DASIN) �___ HEAT PUMP <br /> _ ___ SHOWER ______ UNIT HE•ATERS <br /> �__ KITCHEN SINK & DISPOSAL _____ CLOTHES DRYER <br /> _�_ pIS11WASHER _ _ RANGE fi00D <br /> ____ LAUN�RY TRAY ___�^_ WATER HEATER <br /> ,___ CLOTHES WASHER _�_,__ METAL FIREPLACEISTOVE <br /> ,__ URINAL ��^_ FIREpLACE INSERT <br /> _ ORINKING FOUN7AIN �__ GAS FIREPLACE <br /> „_ FLOOR DRAIN _�_ GAS RANGE <br /> ____ 6ACKFLOW PREVENTL-R ,�_ GAS PIPING <br /> _R_ SINK �SERVICE/BAR/MOPIETC,) ____ EXHAUS7 FAN <br /> _�_._ 07HERA,�-- ^�--- —�- 07HER__----- <br /> 1 HEREBY CERTIFY THAT I HAVE READ AND E7(AMINED THIS APIICATION AtiD KNOW THE ShR1E TO 6[TRUE AND CORRECT.ALL <br /> ?ROVISION$OF LAWS AND OROINANCES GOVE-RNING THIS TYPE OF WOF:K WILL BE COMPLIEO WIHT WHE7HER SPECIFIEO HC•REI <br /> OR NUT. iHE GrtANTING OF A FERh11T DOES NOT PRESU�aE TO GIVE nUTh�ORITY TO VIpLaTE OR CANCEL THE PROVISION OF aNY <br /> OTHER SiATE oR LOCnI,LAW REcuLArING coNSTRUCTION OR THE PEf2�'ORMANCE OF CONSTRUC710N.THATI AM AUiHORITED <br /> BY THE OWNER Of THIS PROPERTY TO PERFORM THE WORK FOR WHICI APPLICATION IS MNDE AND 1 COMPLY WI7H TME STATE <br /> CONTRACTORS LAW t 8.27 RCW ANO :Q6.200 WAC. <br /> Signature of Owne�ICant�actorfAuthorizod Agoni _, ,' ,.,4 ,r '�. �, �ata U6;121ZUOG <br /> w,:i <br />