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MAY-06-2011 13:01 From:4258149516 Paee:314 <br /> PERMIT APPLICATION 540005 <br /> 04M CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 g4 `'/ <br /> 425-257-8857 FAX <br /> SITE ADDRESS PARCEL TAX I.DX PERMIT# <br /> 323 60 ST SE, EVERETT, WA 98203 00471700003202 1 <br /> f OS -O► <br /> LEGAL LOT NO. BLOCK TRACT <br /> OWNER ADDRESS PHONE <br /> RANDOLPH,JOHN 323 60 ST SE (425)350.0114 <br /> EVERETT,WA 98203 <br /> TENANT NAME CONTACT NAME PHONE <br /> kVe— C Q 425836-70 <br /> CONTRACTOR ADDRESS CONTMLICENSE# <br /> FAST WATER HEATER COMPANY 12601132ND AVE NE FASTWWH948BC <br /> ptjONE 425.836-7t7$4 KIRKLAND, WA 98034 01/04/2012 <br /> PROPOSED USE OF BUILDING BuildingIN Mechanics WORKNA11irrati <br /> Addlnon H AT SOURCE <br /> PERMIT Combination Plumbing m leetrie <br /> Residential TYPE DemollUon Slgn TYPE New as <br /> S Rai Cher <br /> CONTRACT PRICE OF WORK ' T LOC <br /> CITY OF EVERETAL SALES TAX CODEIS 9105 <br /> WORK DESCRIPTION Remove/Replace Gas Water Heater <br /> PLUMBING MEQHANICAL <br /> NO. TYPE OF FIXTURE QIR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET AIC-A/HANDLING UNITS <br /> BATIITUI3 FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 6 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY 1 _ WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> T URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK ISERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER <br /> I HERESY CERTIFY 111AT 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 HERE/ <br /> OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED <br /> BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> Signature of Owner/Contractor/Autharl:ed Agent Date 0510412011 <br /> an Jm <br />