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� <br />PERMIT APPLICA,�'�ON <br />cir�r oF �1�ER�Tr P�RM�T sERv�c�s <br />3200 CEbAR STR�ET, EVERETT, WA 98209 <br />425-257�8'{ 0 — �AX �425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO q� PM <br />SIT ADDRESS <br />03 Q 'a <br />LEGA LOT NO. BLOCK <br />DESC. <br />OWNE{� <br />1►►�� <br />�NaNr r�anne <br />7RAGTpR ��,y`p_,n `� <br />CON7R. uCEN8E # <br />�r�,,-�.1�a <br />USE OF BUILDIidG <br />TA7C I.D. # <br />TRACT OR 3UBDIVISION � <br />qDDRF_9S <br />IiC-ONTACT FQR P�RAAIT <br />.�A.� r�lia � c� �''i�iti.�c.-� <br />� �1��i � i _ <br />WORK D�SCRIPFION <br />�p�n c'e" C� q,. ��� r� i� <br />�� �-` <br />N�• f TYPE OF FIXTURE OR 17EI1A <br />Toi �et <br />Bathtub <br />Lavatory (wash basin) <br />Shawer <br />Kikchen sink & dispoea! <br />DishWasher <br />Clothes washer <br />W[�te� h9ater <br />5ink (servicelbar/mop/etc.) <br />8ackfloW p►eventer <br />Urinal <br />Drinking Fauntain <br />Floor drain <br />Grease trap <br />Roof drains <br />Othar <br />�'� <br />GI7YIztP PHONE <br />� � 3� 3 - �l c�� <br />PHORiE � ��a .,[ L� U ��l OO <br />�-�n��U !'ri.i ����'�f.M-r�v�+' <br />CITYIzlP � <br />���� a�� a a � a� � <br />�1 �+ �C ` <br />HEAT SOUiiCE Cp1qTRAGT PRiCE OF WORK <br />` Eleetric �G�s � Other J� a� <br />MECh#ANICAL <br />N0. I TYP� OF FIX'NR� OR IT�M <br />A/C — air handling unifs <br />� Fvrced air system5 <br />Gas piping <br />Water heater <br />Gas �r�pl�� <br />Gas ranga <br />Ciofhes dryer <br />RangB �ood <br />E�haust fan <br />Weat pumA <br />� Unit he�tef <br />� �oiler <br />� i�efrigeration <br />�, Woodstove <br />Oiher <br />CtrY OF Ev�R�'T �OC�v. sai�.4 r�,ac coe� is a�os <br />I hereby Certify thak I have read and examined this appfication and knaw the same to ba true and con�ect All provisfons of laws and <br />°�"'��'�s 9°Vem��9 ��g tYAe fl� Wori� wUl be complied with whether specffled herein p� no#. The granting of a permit does not pr�esume <br />to give authoriry to violate or cancel fhe pravisipn of any ofher stat�e or local law rwgulat;n9 �o►,struc�on o� the p�rk,R„ance of <br />co ctfon, That I am authoriz d by the owner of this property ta pe rm th work for which applica�on i� made and I comply wftP� the <br />Sfate ontr2ctors Law 18.27 and .200 WAC. <br />ature of1 wnerlContrart r� �� �ry��.� n.,,,.,� �"�. � <br />,. <br />c'.c rr <br />