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Irun: <br />O6�""'/2007 11:42 p744 P.002/002 <br />PERMIT APPLICATION 370648 <br />��i��CITY OF EVERETT PERMIT SERVICES <br />` 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />425-257-8857 FAX <br />SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br />,, u� s r si:. rvriir rr. u n �a^_oR noa�n00000t�ou <br />LEGAL LOT NO. BLOCK <br />DE� — <br />OWNER ADDI2ESS <br />�z� �» s 1 si�. <br />171:1N. ti.4RA'fll <br />- -- I�.VI-.Itl'.1�1�. N'A 9R2UN <br />Pamela Hill <br />CONTRACTOR ADDRESS � <br />1'.4ST WAII:R HGA'ff:Ii COMPANY 12G01 137.ND AVP. NI�. <br />IiIKRI..AND, WA 9R074 <br />,p�ONE taz5)sia��i�a <br />PROPOSED USE OF DUILDING 6ulldinp M�eh�n�c� WORK <br />PERM�T Cambin�llon PlumOlnp <br />TVPE D�molilion sipn --- T`�PE <br />CON7RACT PRICE OF WORK b4A9.00 , CITY OF EYERET <br />WORY. DE9CRIPTION µcmovel(tepince (ias Wnter I lcnirr <br />� WATER CLOSET <br />.._.... --- BATHTUB <br />_____ LAVATORY (WASH BASIN) <br />SHOWER <br />NITCHEN SINK 8 DISPOSAL <br />DISHWASNER <br />LAUNDRYTRAV <br />CLOTNE3 WASHER <br />URINAL <br />ORINKING f'OUNTAIN <br />FLOOR ORAIN <br />� BACKFLOW PREVENtER . <br />_` SINK ISERVICEIBAR/MOP/ETC.) <br />OTHER ___ _. -------_ <br />PHONE <br />(425)'G8�359� <br />800-A54-89.55 x 133 <br />CONTR.LICENSE# <br />PASTW�4'H?4RBC <br />01 /03 R008 <br />SOURCE <br />LOCAL SAI.ES TAX <br />AIC-A/HANDLIN6 UNITS <br />FORCED AIR SY3TEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOU <br />� WATER HEATER <br />� METAL FIREPLACEISTOVE <br />FIREPLACE INSERT <br />� GAS FIREPLACE <br />GAS RAN6E <br />__�_ GAS PiPIN� <br />---- <br />EXHAU3T FAN <br />----- OTNER--------------------��— <br />----- -------- -'----------- ---- -- <br />I---- ----------- -------------- I ---- I --------------------- <br />�� I HEREHY CLRTIFV iHAT I MAVE RF.AD ANIJ EXAMINEO 7HIS APLICATION AND KNOW TNF SAME TO BE TRUE AN� CORRECT.ALI <br />PROVISIONS OF IAWS AND ORDINANCFS GOVFRNING THIS TVPE OF WORK WILL BE COMPUED WIHT WMETHER SPECIFIED HERE <br />OR NOT. TME ORANTING OF A PERMII D'JFS NU! 1'RESUME TO OIVE AUTNORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE VEFFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZED <br />Bv tHE OWNER OF ?HIS P ROPERIY TO PERFORM TNE WORK FOR WHICH APPLICATION 19 MAOE AND I COMPLV WiTH THE STATE <br />iCONTf7ACTORS LAW itl27 RCW AND 2UH.900 WAC. <br />SlpneWre ol OwnorlCanlracrorlAuthorizetl Apen� �,.-- -,'.r _ti/� �'%' � <br />Dats OfiiU/2U07 <br />u�rn <br />