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,- - Rr-RMIT APPLICAM V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />., ( K 1938 <br />SITE ADDRESS <br />PARCEL TAX I.D.# <br />PERMIT# <br />a^__'') 61 s l si . 1 %'1 JtC r l . k1'A 98203 <br />On3929uu2u09n 1 <br />ill >Z�/ <br />LEGAL <br />LOT NO. <br />BLOCK <br />D_E <br />(TRACT <br />OWNER <br />_ <br />ADDRESS <br />PHONE <br />(IGLt W. SCOTT <br />1 229 63 ST Sli <br />(-1251347-ih811 <br />• [AAA li'I'T, WA 98203 <br />TENANT NAME <br />CONTACT NAME <br />PHONE <br />PANIFLA IIILL <br />42i 811-312d c133 <br />CONTRACTOR <br />ADDRESS <br />CONTR.LICENSEtt <br />PAST WATER IWATER COMPANY <br />12601 132ND AVE NEi <br />PAS']11'I1(PHONE 1r211F <br />(425)814-3124 <br />KIRKLAND. WA 9803'1 <br />0' 16 2005 <br />PROPOSED USE OF BUILDING <br />Bum Mathanlca <br />— <br />WORK <br />Add,tIo� <br />HEAT SOURCE <br />PERMIT <br />In <br />Comhlnallon Plumbing <br />• Allerabon <br />Electric <br />TYPE <br />Demolition Slgn <br />TYPE <br />New <br />as <br />r r <br />Roos r/Malnl <br />CONTRACT PRICE OF WORK .13.19.00 <br />Ih-r <br />ICITY OF EVERE"T LOCAL SALES TAX CODE IS 1105 <br />WORK DESCRIPTION <br />Rcmmc Replace I!Iccuic N'alcr Ilealrr <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_______ <br />WATER CLOSET <br />_______ <br />--" <br />A/C-A/HANDLING UNITS <br />------- <br />BATHTUB <br />_______ <br />FORCED AIR SYSTEMS <br />------- <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />------- <br />SHOWER <br />--__ <br />UNIT HEATERS <br />------- <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />__ _ <br />RANGE HOOD <br />------- <br />LAUNDRY TRAY <br />I - <br />WATER HEATER <br />CLOTHES WASHER <br />--__ <br />METAL FIREPLACEISTOVE <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />—__ <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />---- <br />OTHER--------------- <br />------ <br />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 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 IAM AUTHORIZED <br />BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296 20D WAC. <br />Signature of Ownericontractor/Authorizad Agani 'c , Datc 01'1'-'_D0 <br />1 <br />