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- P-RMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> rrr 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> CK 1794 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 2517 911 PI,SE,EVERETT,WA 98203 00691100000100 fn Oy 12-OICJ <br /> //' <br /> LEGAL LOT NO. SLOCK (TRACT <br /> DE <br /> OWNER ADDRESS PHONE <br /> 71iRRY,GRE2517 80 PI,ShGORY R LINDA (425)347-3058 <br /> • IiV1iRETT, WA 98203 <br /> TENANT NAPE CONTACT NAME PHONE <br /> MV 3-51117IINCONFIRNII":D I'ANIFI.A 1111.1, 425 814-3124 x133 <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> FAST1VA IHR I II'.A FlAt COMPANY 12601 132ND AVL NE LAS I'Wl IC052D1 <br /> PHONE (425)81.1-3124 <br /> KIRKLAND, WA 99034 02'162005 <br /> PROPOSED USE OF BUILDING BuildingMachaniCa WORK Addille- HEAT SOURCE <br /> PERMIT Cambinallon Plumbing Alteration I DElectric <br /> 7YpE Demolition Sign TYPE New as <br /> _ <br /> rtnkler Ra airlMalnl Cher <br /> CONTRACT PRICE OF WORK 0.111 00 CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br /> WORK DESCRIPTION Itcinm e'Replace Electric Water Hemet <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM 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 & DISPOSAL ______ CLOTHES DRYER <br /> Dt�,HWASHER __ _ RANGE HOOD <br /> LAUNDRY TRAY I WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <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 /> -- - 07HERA-------- ---- OTHER----------------------- <br /> I 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 WIH T WHETHER SPECIFIED HERE( <br /> OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OP,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/Authorized Agem Date 11/301200.1 <br /> UI}4i <br />