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Sent By: HP LaserJet 3100; 425824951fi; Mar•37 -06 11 :t0AM; Page 3 <br /> � <br /> � <br /> PERMIT APPLICATION <br /> �i�� CITY OF EVERETT PERMIT SERVICES <br /> �e 3200 CEDAR STREET, EVERETT, IVA 98201, 425-257-F3810 <br /> o�s i uo <br /> SITE ADDRESS PARCELTAX I.D.t� PERIfl1Tt1 <br /> 10821 1 DR 5G,EVIRETI',wA yR20A 00391500004;00 /Y�/ �%� ��' <br /> �� �l <br /> LEOAL LOT NO. dLOCK �TRACT <br /> OWNER ADDRESS ! PNONE <br /> 10821 1 UKSF. (q25)755-ti982 <br /> BURfO�,JACI� , ��RfifT,WA 98208 <br /> TENANTNAME CONTACTNAME PHONE <br /> PAML•LANILL 425 R14-31'_arl?? <br /> CONTRACTOR ADDRESS CONTR,LICENSE� <br /> FASTW�TCILHFA'I'LRfOMPAVY 12601132NDA\'GNF. FAS'fW�VH446AC <br /> KIRKI.AND,\4A 9803J 01/03R008 <br /> (425161d-7124 <br /> PROPOSED USE OF BUILDING �°�1d1np M""'""' woRK N�°a;tl� M Tk OURCE <br /> PERAll7 CombinQbn V'umbinp TMPE � „ <br /> TMpE Mmdlllon son <br /> w .na � . <br /> CONTRACT PRICE OF WORK 5349.00 UTY OF CVERETT LOCAL SALES TAX CODEIS S�OS <br /> WORK DESCRIPTION RcmovvRcp�uceEkctric Water Heuter <br /> Qj,UM81NG NEQHANICAL <br /> 0 FIXTURE R ITEM F T EM <br /> WATER CLOSET ______ A(C•AIMANDLINO UHIT9 <br /> /ATHTUB _�__ FORCED AIR 5Y57EM5 <br /> LAVATORY (WASM BASIN) ___ MEAT PUMP <br /> SHOWER ._� UNIT HEATERS <br /> � KITCHEN SINK 6 GISPOSAL �_ CL01ME5 ORVER <br /> r DISNWASHER __ _ RANGE NOOD <br /> ^ IAUN�RY TRAY _�_ WATER HEATER <br /> CLOTHES WASNER ___._ METAL FIREPLACFJSTOVE <br /> V l RINAL ___ FlREPLACE INSERT <br /> DRINKIHG FOUNTAIN �`_ 6A9 FIREPUCE <br /> FLOOR DRAIN ,_____ GAS RANaE <br /> BACKFLOW PREVEN7ER ,� GAS PIPIN6 <br /> 91NK (9ERViGEIBARIMOPlETC,► ,� EXHAUST fAN <br /> -- _ oTHER_ _ �_ OiXER----- -------- <br /> 1 HERE9Y CERTIFY THAT I MAVE RE/1D AMD E%AMINED TMIS AMICATIDN A�ID KNOW TME SAME TO BE iRUE ANDCORREC7.All <br /> PRUVISIONS OF LAWS AND ORDINANCES GO��LRNMG THIS TVPE Of WOVtK WILL BE COMPUEO WIHT WHETHER SPECIFIEO HERE <br /> OR NOT.TME GRANTING OF A PERMIT DOES NOT PRESVME TO GNE AUThORIiY TO VIOL.ATE OR CANCEL TF�E PROVISION Of ANY <br /> BY TME OW ER OF�TN 5 ROPERTY OTPEttFORM TTiE WORK OR WM CI�APPLiCAT10N IS�MME ANDwCOMPLY WI�TH THE ST TED <br /> CONTRACTORS LAW 18.27 RCW AND ZD6.200 WAC. <br /> SI neturo of OwnadContradorlAulhorised Apenl -- '� -- ,c r'"�. -y��• O�ta 031J1r,00G <br /> 9 /`_- :"'"- �, <br /> o�.ni <br />