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Sent By: HP LaserJet 3100; <br />4258249516; Aug-8-06 1:20P1,1; Page 4/5 <br />,-�� P'tRM17 APPL�CATIUN <br />CITY OF EVER�TT PERMIT SERVICES <br />�_� 3200 CEDAR STREET, EVERETT WA 98201, 425-25�-8810 <br />ososuo <br />SITEADDRESS PARCELTAX I.D.# PERMIT# <br />2,;'7 KOCKL•'FLLLGIt.4VH, F.VP.FRtt, l�'A 95201 0043�JId92014UU �i� U�U�'' �J � �j <br />AL <br />OWNER <br />SHRIV[R, Ii.4THRYN <br />TENANT NAME <br />CONTRACTOR <br />F:1ti'I' �1'A fL}t IiCATHR CO\1PANY <br />PHONE �'�'s)S1J-;�i?a <br />PROPOSED USE OF BUILDI <br />ADDRESS <br />^sz� Ttoc�:FFrL�c� .av� <br />� EVERETT. Wn y5'_UI <br />COPITACT NAME <br />PAMELA HILL <br />ADDRESS <br />12601 l 3'D� D A V F N F. <br />KIILIiL.�ND. R'A 93U3 t <br />Bulltlinp <br />PERMI7 ComGlnallon <br />TYPE [JDamvlilion <br />CONTRACT PRICE OF WORK g3qq.pp <br />WORK DESCRIPTION kemo�eiRrpl:icc Elcctrit W�ter Ileater <br />� <br />WATER CLOSET <br />BA711TU6 <br />L4Vn70RY (WnsH BAsiN) <br />SHOWER <br />KITCMEN SINK R DISPOSaL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKF�OW PREVENTER <br />SINK (SERVICE�BARIN,OP/ETC.) <br />�'Ium0ing W'�n� <br />��e� TYPE <br />EVERETT <br />ME�IIANICtq_L <br />PHONE <br />���_�_52-s?r�a <br />PHONE <br />4:t S1aJl'_as133 <br />CONTR.LICENSE# <br />FAST\VN'H9•1'�BC <br />Uli(13i?bJ8 <br />H�"i 50URCE <br />Elcciri: <br />at <br />ther <br />TA7( CODEIS 3i05 <br />_„ �___ FORCED AIR SYSTEMS <br />--_�- MBA7 PUMP <br />�___ UNIT HEATERS <br />_______ CLOTHES ORYER <br />__ _ RANGB HOOD <br />1 WATER HEATER <br />___�__ METAL FIREPUICEISTOVE <br />____ FtREPLACE INSERT <br />____, . _ OAS FIREPLACE <br />�__ GAS RANGE <br />GAS PIPING <br />,____ EXHAIJST FAN <br />------- OTNER__------------- <br />------ i ------------------------------- i ---- I -------------------------- <br />I HERC-6Y CER?IFY THA i i HAV� R[AD ANO EXAIdMED THIS AP�IGATION P VI> KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />PROVISIONS OF lAWS nnlo oRoiNnNCES GOVGRrriNG TFUS tYP[ or w0�<IVIIL BB COMPLIED WIHT WNETNER SPEGFIED NERE <br />OR NO?. THE cRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUT� �ORITY TG VIOLl1TE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCA4 IA�V REGU�ATING CONS7RI1C710N OR ThE Pcf• FORMANCE OF CON ;TRUCTION. THAT I AM AVTHORIZED <br />0r 7H[ OWNER OF 7HI5 PROPERTY TO PERFORM1I TNE WORK POR WHIC.i APPUCATION IS MAOE AND t COMPLY WI7H THE ST�TE <br />rnNTRACTnRR LAW 18.27 RCVJ AND 298.200 WAC. <br />of OwnedContracmrlAuthorized Agoni . �� .. .. Oate 08-03'�OC�h <br />w em <br />