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�r-on: 12/27/2�09 15:14 tt010 P.002/002 <br />PERMIT APP�LICAilO(� 4'Z°Z� <br />�wi��CI'rY OF EVERETT PERMI'� SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />425-257-8857 FAX � � � yZ_ <br />SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br />10425 3 llR SE, tiVCRti7'T, WA JR20R 00397000003405 <br />iM ��a �o <br />LEGAL LOT NA. BLOCK �7RACF <br />D E. <br />OVI7NER ADDRFSS PHONE <br />10425 ft DR SL' <br />PRAD, TOMM V !425)931-8000 <br />• CVERtiTT, WA 98208 <br />TENANT NAME CONTACT NAME PHONE <br />Carol Randall 425-636-7054 <br />CONTRACTOR A�DRESS CONTR.LICENSE# <br />PA57' �VATEIt LICATGR COMPANY 12601 132ND AVE NG I'AST�V WI1948DC <br />KIRKLAND, NA 98034 01/04/ZO10 <br />425-636-7054 <br />PROPOSED USE OF BUILDING Duildfnp 6tachan�ca WORK Addition HEAT SOURCE <br />PERMIT Combinafion Plumhing � Altoralion Electric <br />Residentlal 7ypE Domoli�ion Sign TYPE New as <br />rl I r Re airlRlaint thcr <br />CONTRACT PRICE OF WORfC �449.00 CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br />WORK DESCRIPTION Removc/Rcplace Gas 1Vatcr Ileuter <br />ALUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR IT[M NO. TYPE OF FIXTURE OR ITEM <br />_____ WATER CLOSET _____ AJC•A11iANDLING UNI7S <br />_____ BATHTUB ,__ FORCEO AIR SYSTEMS <br />______ LAVATORY (WASH BASIN) ___ HEAT PUMP <br />_ SHOWER UNIT HEATERS <br />_____ KITCHEN SINK & DISPOSAL ___ CLOTHES DRYER <br />__ DISHWASHER RANGE HOOD <br />_____ LAUN�RY TRAY I__ WA7ER HEATER <br />____ CLOTHES WASHER .�_ METAL FIREPLACEISTOVE <br />___ URINAL _�_ FIREPLACE INSERT <br />__ DRINI(ING FOl1NTAIN GAS rIREPLACE <br />___ PLOOR DRAIN _^ GAS RANGE <br />__ BACKFLOW PREVENTCR GAS PIPING <br />____ SINK (SERVICEIBARlMOP/E7C.) _� EXHAUST FAN <br />__ OTHER, ___ p7HER___^________,__ <br />1 HEREBY C[RTIFY TFiAT I HAVE READ ANU EXl�MINEO THIS APLICATION AND KNOW THE SAME TO BE TRt1E AND CORRECT. AlL � <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLIED 4VIHT WHETHER SPECIFIeD HEREI <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLA7E OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AU7HORIZED <br />BY THE OWNER OF THIS P'?OPERTY TO PERFORh1 THE WORIC FOR WHICHAPpLICATION IS MADE AND 1 COMFLY WITH THE SiATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />Signatura of OwnodCoMraetor/Authorizod Agont �,�,�����p DBte 12/22/2009 <br />m mi <br />