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From: 07l79/2010 08:48 x007 P.002/002 <br /> � <br /> PERMIT APPLlCATiON 501423 <br /> ��� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> 425-257-8857 FAX �—�-q �/D <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT�! <br /> ssos i.i na w r.n, r:vf;�tr7 r. wn �xao� oos�i��oosooioo (� I C " 0/ / <br /> 1 ° I `t <br /> LEGAL LOT N�D. BLOCK ITRACT <br /> OWNER ADDRESS PHONE <br /> sAos ia ori w an <br /> NICLSf'V. SCOT"I' (.125)349-2125 <br /> • [iVC•RL:'I�l'. 1VA 95203 <br /> 7ENANT NAME CONTACT NAME PHONE <br /> Carol Randall 425-636-i054 <br /> COPITRACTOR ADDRESS CONTR.LICENSE# <br /> I'AS'I- U'A�I'fi.it IIf�.A�1�P:K COMPANI' IZG01 132ND AVC NE I'AS-I'\t'\VI19�1SLiC <br /> 425-G36-7054 ti�KKLANU, WA 9503-1 01/04/2013 <br /> PROPOSHD USE OF BUILDING eu�minp Machan�ca Additlon HEAT SOURCE <br /> PERMIT Com6lnalion Piumbinp WORK , ,q�teraUon Electric <br /> Residenli�l TypE Demolilion Slpn T�'PE Naw ae <br /> rl kl r Re airlMalnt ther <br /> CONTRACT PRiCE OF WORK CITY UF EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION <br /> Rcini�ec/RcpLicc Gas 1Vatcr Hcaler <br /> PLUM6ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO, T PE OF FIXTl1RE OR ITEM <br /> ______ WATER CLOSET _ A/C-A/HANDLING UNITS <br /> ____ BATHTUB fORCE�AIR SYSTEMS <br /> ______ LAVATORY (WASH BASIN) � _ HEAT PUMP <br /> __�__ 5HOWER _ UNIT HEATERS <br /> __,___ KITCHEN SINK & DISPOSAL _ CLOTHES DRYER <br /> ___ DISHWASHER RANGE HOOD <br /> _____ LAUNDRY TRAY � � WATER HEATER <br /> _� CLOTHES WASHER METAL FIREPLACEfSTOVE <br /> ____ URINAL _ FIREPLACE INSERT <br /> ___ DRINKING FOUNTAIN � GAS FIREPLACE <br /> _ FLOOR DRAIN � GAS RAtJGE <br /> ____ BACKFLOW PREVENTER GAS PIPING <br /> ___ SINK (5ERVICEIBAR/MOPlETC.) EXHAUST FAN <br /> ---- OTHER -- --- ---- OTHER-------------- <br /> 1 HEREBY CERTIFY THqT 1 HAVE READ AND EXAMINED THIS APLICATION AN�KNOW TH[SAME TO BE TRUE AND CORRECT.All' <br /> PROVISIONS OF LAWS nND ORDIMAN::ES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WIHT WHETHER SPECIfIEO HEREII <br /> OR NOT.THE GRANTING OF A PGRMII"DOES NOT PRESUME TQ G�VE AUTFiORITY TO VIOLA7E OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL lAW REGULATlNG CONSTRUCTION OR TNE PERFORMANCE OF CONSTRUCTIOh.TNAT 1 AM AUTHORIZEO <br /> BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITFi THE STATE <br /> CONTWICTORS LAW 18.27 RCW AND 296.200 N,'qC. <br /> Signaturo o(OwnodContrectorfAuthorizad Agent ��y w���L�����QP �ate <br /> J o�n_�n_oio <br /> U��91 <br />