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Sent By: HP Laser•Jet 3100; 4258249516; l.1ay-23-0� 12:22PlA; Page 3/3 <br /> ( � 1 <br /> PtRMIT APPLICaTIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> "�r 3200 CEDAR STREET, EVERETT, 1'VA 98201, 425-257-8810 <br /> U52J0( <br /> SITE ADDRES3 PARCEL TAX I.D.# PERMI7# <br /> 4924 GLACIERLN, h'\'GRETT, wa �szos oo��>>��aouz:oo M o�c� s-os� <br /> LEGAL LOT NO. BI.00K ITRACT <br /> DE <br /> OWNER ADDRESS PHONE <br /> GHOFF, BAI:I.fARA ��z4 GLACILIt I.N (425)339-$379 I <br /> • EVHRL"CI', �VA 982U3 <br /> TENANT NAME CONTACT NAME PHONE <br /> p/�h7F.LA HILL 425 31d-3121 �133 <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> FAST\VA'fL•'RIIF.AI'rKC0�9PANY 12(i01132NDAVGNE FAS'l'W1U119488C <br /> KIRKL.ANfI. \�'A 95034 Ul/U3/200R <br /> (a25)8I4-3I24 <br /> PROPOSED USE OF BUILDING aui�diny M��ch�nlca WORK AAd�11O� HEAT SOURCE <br /> PERMIT CortlbinYt108 ' PIurtlDing - Nlw�Uon EIecMC <br /> T`fPE Domollllon Lj51.�,i �P� N�w aa <br /> nkl r R� airlMdN ther <br /> CONTIiACT PRICE OF WORK S349.00 CITY OF EVERET7 LOCAL SALES TAl(CODEIS ]105 <br /> 1kORK DESCRIPTI�N Remove/Kepincc F.Iccvic 1Vater Hentcr <br /> PLU BING jAECHAI� I�l <br /> NO. TYP OF FIX7URE OR ITEM (l TYPE OF FIXTURE R ITEM <br /> ____ WATER CLOSET ,______ A/C-AINANDLING UNITS <br /> _,__ BA7HTUB „______ FORCE� AIR SYSTEMS <br /> __� LAVATORY (WASH 6ASIN) _��_ HEAT PUMP <br /> ___� SHOWER ,_^_ UNIT HEATERS <br /> ___ KITCHEN 51NK R DISPOSAL ,__„___ CLOTHES DRYER <br /> DISHWASHER ___ _ R�1NGE HOoD <br /> ^ �AUNDRY TRAY ___�__ WA7ER HEATER <br /> �_ CLOTHES WASHER .__ METAL FIREPLACE/STOVE <br /> _, URINAL _____ FIREPLACE INSERT <br /> _,� ORIkKING FOUNTAIN ,__ OAS FIREr'LACE <br /> FIOOR DRAIN ___,__ GAS RANGE <br /> __� BACKFLOW PREVENTER ,_�_ GAS PIPING <br /> __ SINK (SERVICFIBAR/MOPIETC.) ._�_ E%HAUST FAN <br /> ------ OTHER--- . _ OTHER______�__------___..-- <br /> i HERE6Y CER7IFY THAT I HAVE READ AND EXAMINED THIS APLIG�TION A�D KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GQVERNING THIS 7YPE OF WOFK WILL BE COMPLIEU WIHT WHFTHER SPEClFIED HEREI <br /> OR NOT.ThtE GRAN7ING OF A PERMIT DOES NOT PRESUM6 TO GIVE AUTH•�RITY TO VIOLATE OR CANCEL TNE PROVISION OF�NY <br /> OTMER STATH OR LOCAL LAW REGULnTING CONSTRUC710N OR THE PER�ORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED <br /> BY T?1E OWNER OF TI115 PROPERTY TO PERFORM 7HE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY W17H THE STAT� <br /> CONTRACTORS LAW 18.27 RCW ANO 29�.20D WAC. <br /> Slpnature of OwnedControctorlAuthorizod llgnm �r__.`" '-.. �:;'"r:• �C%" ��t� US/23/2006 <br /> tli r.xi <br />