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fron: 04/07/2009 13:28 p978 P.002/002 <br /> PERMIT APPLICA710N "3eee°� , <br /> �wi� CITY OF E�i'ERETT PERMIT SERVICES � <br /> ._� ' 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 (� ` y �p9 <br /> 425-257-8857 FA� <br /> SITE ADDRESS PARCEL TAX I.D.t! PERMIT# <br /> 214 109 ST SG, BVGR�'IT,W�A 98208 0067G500000900 � �� _ /, I � <br /> l, I <br /> LEGAL LOT NO. BLOCK �TRACT <br /> OWNER ADDRE33 PHONE <br /> SA'1'18i1t, I'AI.MBR 214 109 ST SG (q25)3A7-3159 <br /> • GVrRGT7', WA 98208 <br /> TFNANT NAMF CONTACT NAME PHONE <br /> (iRG 6-R2MVf2-^_S539A'KM'1'S45 Carol Rendall 425-838-7�54 <br /> CONTRACTOR ADDRESS CQNTR.LICENSE# <br /> FAS1'WATHR tl[:A'i'BR COMPANY 12601 IJ2ND AV8 NG PASTW WH948[3C <br /> a25-636-7054 k1RK1_AND, 1VA 9803a OIi04R010 � <br /> PROPOSED USE OF BUILDING ew�dino M�e��nl�ea WORK �adinon H T SOURCE <br /> PERMIT Com6ln�llon PIum61n All�ratlon E�ctrlc <br /> TYPE Damolltion 81pn TYPE Naw •s <br /> � Ra aINM�I•t ther <br /> f:ONTRACT PltICE OF WORK ^�349.00 CITY OF EVERETT LQCAL SALES TAX CODEIS S10S <br /> WORK DESCRIP710N �temove/Rcplocc Glcctric WNcr Htalcr � <br /> L UMBI MECHANICAL <br /> TYPE OF FI%TURE OR 17EA O OF TURE O EM <br /> ___ WATER CLOSET ______ AIC•AIHANDLINO UNITS <br /> __ BA7HTUB ____ FORCEO AIR SY6TEM3 <br /> ___ LAVATORY(WASH BASIN) ____ HEAT PUMP <br /> __ SHO�NER ___ UNR HEATERS <br /> ____ KI7CMEN SINI: d DISPOSAL _____ CLOTNES �RYCR <br /> ____ DISHWASHER _ _ RANGE HOOD <br /> �__ LAUN�RYTRAY ___�__ WATERHEATER <br /> __ CLOTHGB WASHER _^_ ME'iAL FIREPIACE/&TOVE <br /> ___ URINAL _�__ FIREPLACE INSERT ' <br /> �_ DRINKING FOUNTAIN ____ OAS FIREPIeGc <br /> ___ FLOOR DRAIN GAS RAN6E • <br /> �____ BACKFLOW PREVENTER __ OAS PIPING <br /> ____ SINK (9ERVICFJBAR/MOP/ETC.) ___ EXHAUST FAN <br /> ------ OTHER — —•— ��__ OTHER------- <br /> 1 HERf:E3V CERTIFY THAT 1 MAVF.RE/�D AND EXAMINEO THIS APLIGTION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AYD OR�IN�NCES GOVERNINO THI9 TYPE OF WORK WILL BE COMPLIED WIHT WH[THER SPECIFIEO HEREI <br /> OR NOT.TNE ORANTING OF A PERMIT COES NOT PRESUME TO GNE AUTMORITY TO VIOLATE OR CANCEL THE PROVI310N Of ANV <br /> OTHER STATE OR IOCAL UW REGULAT'^iG CONSTRUCTION OR TI1E PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED <br /> BV TME OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATIOPJ IS MAD[AND I COMPLV WITH THE STATE <br /> CONTIUCTORS LAW 1B.27 RCW AND 2e8.200 WAC. <br /> SlpnnWre of OwnedCantnetor/Aulhorl:ed Agenl ���p�,7�f��,�,,,�pp D�ts OA/07/2009 <br /> / <br /> u�avi <br /> i <br /> . _ . . . _ .. . I <br />