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Irnn: <br />07/13/2009 11:33 0267 P.002/003 <br />PERMIT APPLICATION 450939 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />425-257-8857 FAX <br />SITE ADDRESS <br />PARCEL TAX I.D.# <br />PERMIT# <br />615 91 PL SW, EVERETT, WA 98204 <br />00699400000300 <br />n <br />LEGAL <br />'NO. <br />BLOCK (TRACT <br />-- <br />OWNER ADDRESS <br />PHONE <br />LAPINGCAO, MARK 615 91 PL SW <br />• EVERETT, WA 98204 <br />(425)328.8616 <br />TENANT NAME <br />CONTACT NAME <br />PHONE <br />Carol Randall <br />425-63G-7054 <br />CONTRACTOR <br />ADDRESS <br />CONTR.LICENSE# <br />PASST WA1 Fit 1ILA1 ER COMPANI <br />12601 132ND AV17 NE <br />FAS1N'WI194813C <br />PHONE 425-636-7054 <br />KIRKLAND, WA 98034 <br />01/04/2010 <br />PROPOSED USE OF BUILDING <br />PERMIT <br />TYPE <br />Dulldinp Mechani& <br />Combinellon PlumbingAllore8on <br />Demolition Sign <br />r <br />WORK <br />TYPE <br />Addition <br />New <br />Re at rIm In <br />H T SOURCE <br />leclrtc <br />sa <br />ther <br />CONTRACT PRICE OF WORK $349.00 <br />CITY OF EVERETT LOCAL SALES TAX CODEIS 3105 <br />WORK DESCRIPTION <br />KenuweAteplace Iaectric Witter Ilcatcr <br />PLUMBING <br />MECHANICAL <br />NO TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />____ <br />WATER CLOSET <br />_______ <br />AIC-A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWE. <br />UNIT HEATERS <br />KITCHEN SINK 6 DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />___ _ <br />RANGE HOOD <br />LAUNDRY TRAY <br />1 <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />_ _____ <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />OAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />SINK (SERVICE/BARlMOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER_____- <br />11, EREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />'; ROVISIONS 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 VIOLAI-E 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 />CONTRACTORS LAW 10.27 RCW AND 206.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent c y�,r2�Gi y"Gr_C'p Date 07/13/2009 <br />of ml <br />