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P1RMIT APPLICAW N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> ('K 1729 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> IP) 77 PL SW. EVERETf, WA 98203 0038960000060(1 <br /> LEGAL LOT NO. BLOCK (TRACT <br /> DE _ <br /> OWNER ADDRESS PHONE <br /> VA'I NY)N.11A11, 31977 PI, SW <br /> EVERETT, WA 98203 (•125)355-7734 <br /> TENANT NAME CONTACT NAME PHONE <br /> PAh1FI.A IIH1. 425 814-312•I033 <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> I'A,I WA I FR I IIA]FR COMPANY 12601 132ND AVE NI: FAS I\%'I I('052DI: <br /> PHONE 1,125181,1-3121 KIRKLAND, WA 98034 0216 2006 <br /> PROPOSED USE OF BUILDING Building Mechanic. Addition HEAT SOURCE <br /> PERMIT Comb lion Plumbing WORK Alleradon Eleclnc <br /> TYPE Demolition Sign TYPE Naw as <br /> r r Re airim,int Ther <br /> CONTRACT PRICE OF WORK 5349 o0 CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION <br /> Remove/Replace Electric Water I Icaler <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _______ WATER CLOSET _______ AIC•AIHANDLING UNITS <br /> _______ BATHTUB FORCED AIR SYSTEMS <br /> _______ LAVATORY (WASH BASIN) _______ HEAT PUMP <br /> _______ SHOWER UNIT HEATERS <br /> ------- KITCHEN SINK & DISPOSAL ______ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY I WATER 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 (SERVICE/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 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 1 AM 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 290.200 WAC. <br /> Signature of Owner/Contractor/Authorized Ageni Date <br /> - - i 1 11192004 <br /> uily <br />