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Sent 6y: HP LaserJet 3100; 4258249516; Jun-20-06 3:41PM; Page 2/2 <br /> PrAMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 , 425-257-8810 <br /> 06�UUd <br /> SITE ADDRESS PARCEL TAX I-D.# PERMIT# <br /> 6 ti0 PI.SF., LVLRETT. WA 98203 0079410000•)300 /6 <br /> LEGAL LOT NO. BLOCK TRACT V <br /> E <br /> OWNER ADDRESS PHONE <br /> VILLA]IFRMOSA,AMIE 660 Pl. SE (425)609-9656 <br /> EV_ERF.I 1, WA 99203 <br /> TENANT NAME CONTACT NAME PHONE <br /> PANIVLA HILL 425 814-3124XIII <br /> CONTRACTOR ADDRESS (FNTR.LICENSE# <br /> FAS1 WATER HLATIIR COMPANY 12(j01 1 32ND AVE NE FAS'fWWH )Inv <br /> KIRKL.AND, WA 98033 0I/0.1;2008 <br /> .N E_1425)914.3124 <br /> PROPOSED USE OF BUILDING Uulldlnp Machanlca WORKNA ,j,a <br /> Aei(ion H T SOURCE <br /> PERMIT Combinallon �lumbinp tIon Electnc <br /> TYPE Demolition 31pn TYPE Naw as <br /> Ra alrlMalnl the <br /> CONTRACT PRICE OF WORK 54-19.00 CITY OF EVERETT LOCAL SALES TAX CODEIS 9105 <br /> WORK DESCRIPTION RemmeiReplace Gas Waierlleatcr <br /> PLUMBING MECHANICAL <br /> NO I TYPE OF FIXTURE ORI [M NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET —----- A/C•A/HANDLING UNITS <br /> BATHTUB �__ FORCED AIR SYSTEMS <br /> ------- LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> ____ KITCHEN SINK A DISPOSAL CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY IWATER HEATER <br /> CLOTHES WASHER METAL FIREPLACEISTOVE <br /> —_ URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER —� GAS PIPING <br /> SINK (SERVICC/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER_------ —__ OTHER------------------------ <br /> 1 HEREBY CERTIFY 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 THIS TYPE OF WORK WILL BE COMPLIED WIHT WHETHER SPECIFIED HEREI <br /> OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AU1 HORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED <br /> BY THE OWNER OF TIIIS PROPERTY TO PERFORM TrIE WORK FOR WHIL H APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CON,-,RACTORS LAW 15 27 RCW AND 296.200 WAC. <br /> Signature of Ownor/Contractor/AulhorIzed Ayom '� �.. Data 00,20;2006 <br /> I <br /> 49 eT <br />