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rwr•-is-�n11 i1:ee F�r�m:aesel4�si� Pa9�:z�3 <br /> ,-�� F cRMIT APPLICATIUN � 532z'e <br /> ���� CITY OF EVERETT PERMIT SERVICES <br /> :1200 CEUAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> aZ�.157-8857 FAX 3 �� ...,� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 1509 107}'I.SN',GV6R:TT, N'A 98204 0055,'.300401109 . . � <br /> j I � - i'% <br /> LEGAL LOT'NO. BLOCK TRACT <br /> �Sr ---_— <br /> OWNER ADDRESS PHONE <br /> DANCi, l'kl 1509 107 P[,SW (q25)876;4608 <br /> • EVEItC•TT, WA 98204 <br /> TENANTNAME CONTACTNAME PHONE <br /> �-essi�a �sr� 425-G36-7054 <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> PAST \�'ATfR11FATGRCOMPANY 1260113:NDAVENG FASTWN'1�94RE3C <br /> ON[ �25-(i36-7051 KIRKLAND. 14'A 98034 Ol/04�012 <br /> PROPOSED USE OI� BUILDING ewidinp M�cha'lo■ WORK Admllon H� SOURCE <br /> CERMIT Combl�allon PlumEln Nl�ratlon IectAc <br /> ResiJential T'ypE D�molilian Slpn TYPE N�w as �, <br /> rl k R� e1rlMalnl lher <br /> CONTRACT PRICE OF iNORK � I�305 —' CITY OF EVERETT LOCAL SALES TAl( COOEIS 3105 <br /> WORK DESCRIPTION Rrmo�'r/Replace Gas N'a�er Heater <br /> PLUMBING � M[CHANICAL <br /> N TYPE OF FIXTURE OR ITEM _ NO. TY � Of FIXTl1RE OR ITEM <br /> ____ WAT[R CLOSET _,___ A/C•A/HANDLING UNITS <br /> ______ BATHTUII „�_ FORCED AIR SYSTEMS <br /> ___.�_ LAVATOF�Y (WASH OASiN) �____ HEAT PUMP <br /> _�__ SMUWEfi _`__ UNIT H[ATERS <br /> �__ KITCMEN SINK d DISPOSAL _`_ Cl07HES ORYER <br /> __�__ DISHWALH[R _ RANGE HOOD <br /> ____ LAUNDH�' TRAY �^,I__ WATER HEATER <br /> ___ CLOTHE:. WASHER __� METAL FIREPLACEISTOVE <br /> .,__ IIRINAL ______ FIREPLACE INSERT <br /> _.�_ DRINKINC FOUNTAIN _ GAS FIRlPLACE <br /> _._ fLOOR DRnIN �__ GAS RANGE <br /> _�__ 6ACKFLC�W pREVENTER �_.___ (3A5 PIPING <br /> _____ SINK (SEI2VICFJBARIMOP/ETC.) ^__ EXNAUST FAN <br /> _____ OTMER_____ __ OTNER____�__ <br /> i HFREEIY CEItTI�Y 7rv�T I H�V[RFJ�D ANU EXAMINBp T�iIS nt�LICAnON ANo KNOW n1E SAMe TO BE TRUE AND CORRECT ALL <br /> PRUVISIONS Uf lAW5/1N0 UIiDINANCFti GpVLRNING TMIy TVPF Of WORN WILL OE COMPUEO WIHT WMETHER SPECIFIED NEREI <br /> OR NOT. T/1E GMNTIN(i OF A P[RMI7 �OCS NOT pRESUME 1 O CNG AUIHORITV TO VIOLATE OR CANCEL THE PROVISIUN UF ANY <br /> UIHEH STAT[OR LO:q� LAW RFGULATING CONSTRUCTION OR TME OERFORMANCE OF CONSTRUCTION.TNI1T UMAUTNORREO <br /> NV TFIE OWNER OF THIS PRpPERTY TO PERfORM THE WORK FOR WHICH APPLICATION I$MA�F ANO 1 COMA�Y W17N TNE STATF <br /> CANTMCTORS LAW 1B.Y7 HCW ANb 296.100 WAC, <br /> Slgnaturo ol OwnerlContreCtor/Aulhnrizod Agenl �a,�_�yy����,�tc�� Date ���14,Z01 I <br /> _ . / <br /> ui�v <br />