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Fram: 06/22/2009 13:57 N981 P.003/003 <br />PERMIT APPLICATION 448419 <br />CITY OF EVERETT PERMIT SERVIC�S <br />._ T 32J0 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />425-257-8857 FAX <br />SITE ADDRESS PARCEL TAX I.D.# PERMITit <br />; 10415 3 DR SB, EVGItfiTT, WA 98208 00397000003403 <br />�\'� - — c� ' J <br />LEGAL LOT NO. BLOCK �TRACT <br />DESC � <br />OWNER ADDRESS f'HONE <br />'I'RUONG, THO 10415 8 DR SE (425)355-5046 <br />• CVCRETT, WA 98208 <br />TENANT NAME CONTACT NAME PHONE <br />Carol Randall 425-636-7054 <br />CONTRACTOR ADDRESS CONTR.LICENSE# <br />�AST WATBR HGATGR COMPANY 12601 132ND AVG NE PAS'fNWN94SIIC <br />425-636-70F4 ���-AND, WA )8034 O V041?O10 <br />� PROPOSED USE OF BUILDING Bulltlinp M�chaniea Additlon IiEAT SOURCE <br />PERMIT Comhinalion Plumoing WORK q7�oraBon Elaclric <br />7YPE Damolilion Slyn TYPE Naw as <br />r Re etrlNlalnt ther <br />CONTRACT PRICE OF WORK yqq9,pp CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br />WORK DESCRIPTION <br />Remove/Replace Gas Water Heater <br />UMBI � MECHANICAL <br />NO. E OF FIXTURE OR ITEM NO. 7YPE OF FIXTURE OR ITEM <br />_____ WATER CLOSET _,__ A/C-A/HANDLING UNITS <br />____ _ BATF{7�g �^_ FORCED AIR SYSTEMS <br />______ LAVATORY (WASH BASIN) ,_` HEAT PUMP <br />� SHOWER ___ UNIT HEATERS <br />_�.__ KITCHEN SINK & OISPOSAL ______ CLO7HES DRYER <br />____ DISHWASHER � _ RANGE HOOD <br />_�_ LAUNDRY TRAY _ 1_ WATER HEATER <br />____ CLOTHES WASHER __ ME7A1 FIREPLACElSTOVE <br />__ URINAL __�_ FIREPLACE INSERT <br />___ DRINKING FOUNTAIN ___ OAS FIREPLACE <br />__ FLDOR ORAIN ___ GA5 RANGE <br />____ BpCKFLOW PREVENTER __ GAS PIPING <br />__,__ SINK (SERVICE/BAR/MOP/ETC.) _�_ EXHAUST FAN <br />_____ OTHER _ _ OTHER___A_T_____ <br />1 HEFEBY CER7IFY 7HAT I HAVE READ AN� EXAMINED THIS APLICATION AND KNOW THE SAME TO 0E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS ANO OR�INANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED W�HT WHETHER SPECIFIED HEREI <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TfiE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCF OF CONSTRUCTION. THAT I AM AUTHORIZEO <br />BY THE OWNGR OF THIS PROPERTY TO PERFURM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />CONTRACTORS LA4V 18.27 RCW AND 298.200 itiAC. <br />Sfgnaturo of Ownor/Contractorizluthorized Agent ���,���„u,��P Date 06/22/2009 <br />J <br />lu� ani <br />