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Sent By: HP LaserJet 3100; <br /> 4258249516; Aug-75-06 7 :19P1.1; Page 3/4 <br /> P`tRMIT APPLICATION <br /> '`V CITY OF EVERETT PER�VlIT SERVICES �_„-0 6 <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 „ <br /> SITE ADDRE55 PARCEL TAX I.D.# PERMIT# <br /> 250i FI\'LKVILR'DI.VI�, F.Vf'hL'1'I'. �VA 95^_p3 <br /> aor,n3�uuuo svUu VVI O(�0�"G�'-�i <br /> LEGAL LOT MO. BLOCK ITRACT <br /> DE � <br /> OWNER ADDRESS � PHONE <br /> �SUJ RIVEIZVIEN RLVD (q25)�i�-fiR2± <br /> PL-?LRS(�N. RORI:R'I' �• L•'�!LkGTT, \t'A 58103 __. <br /> TENANT NAME CONTl+CT NAME PHONE <br /> NnniL�.a �m.i. .�,s si�-3iz� �i?~ <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> Fnti'I' N'.4TRR fIFATHR CO�iYAV\' 1?6111 132ND AVE Nf- PAST\Vwll9;�i�t: <br /> KIILhLA?!fL R'� 9fiO3 i 01:0:�2005 <br /> n (d25)814-31_'-1 <br /> PROPOSED USE OF BUILDING du��d�no rAe�hanlca Additlon HEAT SOURCE <br /> PBRMIT Com6lnelion ' I'lumbinp WORK q��y�aUon kctnc <br /> 7YPE oemoilUon �;�yn NPE New as <br /> dnWer R� alrlMaint �ber <br /> CONTRACT PRICE OF WORK g3q9.00 CIiY OF EVERETT LOCAL SALES TN(CODEIS 1�05 <br /> WORK DESCRIPTION �t�i����,�;R��lucc Elcc[ric �Vater He;��cr <br /> n� MECHANICAL <br /> p. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTIJR R ITEM <br /> WATER CLOSET _____ AlC-AIHANDLING UNITS <br /> BATMTUB FORCED AIR SYSTEMS <br /> ----- LAVATORY (WASH BASIN) ___.�_ HBAT PUMP <br /> - � SHOWER __^__ UNIT HEA7ERS <br /> � KITCHEN SINK 8 DISPDSAL `__ CLO?HES DRYER <br /> � OISHLYASHER ____ __ RANGE HOOD <br /> � IAUNDRY TFtAY ___�__ WATER HEATER <br /> '� CLGTHES WASHER ____ METAL FIREPLACEISTOVE <br /> URINAL _____ FIREPLACE INSERT <br /> � �RINKING FOUNTAIN _ GAS FIREPLACE <br /> ___-- GAS RANGE <br /> _ FLOOR DRAIN —` GAS PIPIN� <br /> T BACKFLOW PREVEN7ER '-"�'- EXHAUSTFAN <br /> , �--- <br /> SINK (SERVICEIBARIMOPIET . --- <br /> ------- oTHER------- ���_ OTHER..--------------------- <br /> I HERE�Y CERTIFY THAT I HlWE f16AD AND EXAMINED THIS APLICATION PND KNOW THE SAME TO 6F��K�c AND CORRECT.ALI. <br /> PROVISIONS OF lAWS AND OftOINANCES GOVERNING THIS TYPE OF WO4K WILL DE COMPLIEG WIHT WHETNER SPEClFIEO HEREi <br /> OR NOT� T�E GRANTING OF A PERAIIT DOES NDT PRESUME TO CIVE AUTt IORITV TO VIOLA7E OR CANCEl7HE PROVISION OF ANY <br /> BY THF OWN[R OF TH SL R PERiY TO PLRPORM THG WORK OR WI C�i APPL CATION ISOAMOE ANDIIOCOMPIY WITH TME STATED <br /> CON7RACTORS LAW 18.27 RCW ANO 298200 WAC. <br /> . . Date �Q�IS!?U06 <br /> Sfgnature o(�nadContracmrlAuthoriznd ABen� . ,_ -;:'�,_ � <br /> n�o�i <br />