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frnn: <br />11/06��007 14:17 q290 P.002/003 <br />PERMIT APPLICATION 'P�679 <br />� I_ CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />425-257-8857 FFU( <br />SITE ADDi2ESS PARCEL TAX I.D.# PERMIT# <br />i"_.� ��H si si , �:veR�rr, WA 9R20A ooaszi0000irnu �`11i / i/ i � � <br />OWNER <br />�'ICII.IA, MANC'P:I.I.A <br />NAME <br />CONTRACTOR <br />r�sr wn'ri ic iu:n ri'r. ccm-tr,�n�v <br />ADDRESS <br />1924 98 SI' Sli <br />� I�.VCRI{�I-'I�, N'A '+R:t�)R <br />—�ONTACT NAME <br />Carol Randall <br />AODRESS <br />iZeot u�nn nvi: Nr: <br />I:IIiK1,AND, WA 9R03�t <br />��E 800-454-8955 <br />PROPOSED USE OF BUILDING PERN <br />TYPE <br />CONTRACT PRICE OF WORK 5449.00 <br />WORK DESCRIPTION Remove/Replace Gns N'atcr I Ie.ucr <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SkOWER <br />KITCMEN SI�1K 6 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKPLOW PREVENTGR <br />SINK (SERVICE/BAR/MOP/ETC.) <br />oTHER <br />Plumhlnp WORK <br />81pn T`�PE <br />OF <br />N�w <br />PHONE <br />(20ti)72A-A9Z� <br />800-454-8955 x 133 <br />CONTR.LICENSE# <br />PA51'W1411'�4RI7C <br />0 I /(11!200R <br />_______ FORCEO AIR SYSTEMS <br />______ HEAT PUMP <br />__ _ UNIT HEATERS <br />__..___ CLOTHE9 DRVER <br />., _ RANGE HOOD <br />I WATER HEATER <br />METAL FIREPLACE/SiOVE <br />FIR£rLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />6A5 PIPIN6 <br />EXHAUST FAN <br />OTHER <br />SOURCE <br />31 <br />I HERE6V CERTIFV THAT i HAVf. READ AND EXAMINEO THIS API.ICATION AND KNOW 7 HE SAME TO BE 1'RUE AND CORRFCT ALL <br />NFOVISIONS OF UWE ANU ORDINANCES GOVERNING THIS TVPE Of WCRK WILL BE C9MPLIEO WIHT WMETIIER SPECI�IF.D MEREII <br />pR NOT. THE (3RANTWG OF A PERMIT DOES NO?� PRE9UME TO pIV[ AU IHORITV TO VIOLATE OR CANCE� THE PROVISION OF ANV <br />DTHER STATE OR LOCAL Ll�W RE(3UlATIN i C(iNSTRUCTION OR TME PERFORMANCE OF CONSTRUCTION. TNAiIAMAUTHORIZFD <br />9Y THE OWNER OF TMIS PROPERTV TO PERPORM THE WORK FOR VNiiCH APPLICATION IS MAOE AND 1 COMPLV WITH TME STATE <br />CONTRACTORS �,AW 1B.Yl RCW AN� 298.T00 WI1C. <br />of OwnerlContnctor/Authorized Agent ��,,;�y�U�„�(��Ip <br />m <br />O�te �I/06/2007 <br />�11 Mi <br />