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;RMIT APPLICAThaN <br />4rF <br />'r CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />C'K 1306 <br />JI I t AUUKE55 I PAR PERMIT# <br />I I I 1 90 ST SW 44, EVERETT, WA 98204 28041300201700 I11r d <br />LEGAL <br />DE <br />LOT NO. <br />BLOCK <br />ITRACT <br />OWNER <br />ADDRESS <br />T%JI MIO '111A. DFAN. <br />1122.1 NF 117 ST <br />• KIItKLANU, WA 98034 <br />409.5081 <br />TENANT NARSE <br />CONTACT NAME <br />SIILRIt1' <br />PMII'.Ln IIILI_ <br />NE <br />CONTRACTOR <br />ADDRESS <br />814-31_'4 r133 <br />FAST WATER HEATER COMPANY <br />12601 132ND AVE NE%VI <br />TR.LICENSE# <br />LENE <br />IC052Di' <br />PHONE (425)814-3124 <br />KIRKLAND, WA 98034 <br />105PROPOSED <br />USE OF BUILDING <br />Building <br />Machanlca <br />AdH <br />Combination ' <br />Plumbing WORK <br />T SOUPERMIT <br />AltElectricTYPE <br />Damo{itlon <br />Slpn TYPE <br />NeasCONTRACT <br />PRICE OF WORK <br />RetheIrS3a9•UO CITY OF EVERETT LOCAL CODEIS S. <br />WORK nPSromTlnu <br />- ---- —'- Remove/Replace Electric N;ucr IIcalcr <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />--__ CLOTHES WASHER <br />—_ URINAL <br />--__ DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />- ----- I wu-wnr+r.;;iING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />--_ UNIT HEATERS <br />—_—__ CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />--__ METAL FIREPLACE/STOVE <br />---_ FIREPLACE INSERT <br />--_ GAS FIREPLACE <br />—_—_ GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER______ <br />----------------- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED T nla APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS ' /PE OF WORK WILL BE COMPLIED WIHT WHETHER SPECIFIED HEREIr <br />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME -0 GIVE AUTHORI IY 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 I COMPLY WITH THE STATE <br />'ON TRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />(Signature of Own or/Contractor/Authorized Agent ,.. — Date <br />07/07/2004 <br />Ui .'L <br />