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; -��� F .=RMIT APPL�CATiJN <br />CITY OF EVERETT PEi�MIT SERVICES <br />.._ 3200 CEDAR STREET, EVERETT, WA ��201, 425-257-8810 <br />ctci>za <br />SITE ADDRESS PARCEL TAX I.O.# PERMIT# <br />4909 9 AVF. W. FVERETT. 1VA 9R<'03 <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />%fM171NA, \VILLIAM <br />TENANT NAME <br />oms i i 0000noo <br />ADDRESS <br />4909 9 A V L 1V <br />• IiV[iRLTT. \VA 93203 <br />�CONTACT NAME <br />P.-\MtiLA Ii1LL <br />CONTRACTOR ADDRESS <br />PAST WATBR IiEATBR COMPANY 12G01 132ND AVL' NL <br />�d25)814-312d <br />PROPOSED USE OF BUI <br />KIRKLAND, WA 9R03�J <br />Combination I�Plumbing Y�via <br />Demolition �Slgn TYPE <br />CONTRACT PRICE OF WORK 5449.00 <br />WORK DESCRIPTION Removc/Rcplacc Gas Wa�cr Ilcalcr <br />____ WATER CLOSET <br />BATHTUB <br />____ LAVATCRY (1NASH BASIN) <br />SHOWER <br />KITCHEN SINK $ DISPOSAL <br />DISHWASHER <br />_ _ LAUNDRY TRAY <br />CLOTHES WnSHER <br />URINAI. <br />� DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_�_ SINK (SERVICFJBARIMOPIETC.) <br />UTHER <br />i'v� d`{pa,-O a,5 <br />PNONE � <br />;435)252-1621 � <br />� <br />PHONE <br />42. 514-3124 a133 <br />CONTR.LICENSE# � <br />PASTWI IC052DP <br />02;16i2005 <br />iHon HEAT SOURCE <br />CITY OF EVERETT LOCAL SALES <br />� <br />A/C-A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATE�.S <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACEiSTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />I HEREBY CERTI�Y THAT i HAVE READ AND EXAMINED THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING � HIS 1YPE OF WORK'NILL BE COMPLIEO WIHT WNcTHER SPECIFIED HERE <br />OR NOT. THE GRANTING OF A PERMIT DOES NCT PRESUM1IE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAI. LAW REGULATING CONSTRUCTION OR THE PERFORA7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED <br />BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH�CH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />Signature of OwnedGontractorlAuthorizod Ageni i� � i� ��1�_ j�� Data �„� I/3004 <br />wi oZi <br />