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SITE <br />LOT N0. <br />DESC. <br />PERMIT APPLIC,A�ION <br />CITY OF EVERETT PERM�T SERVICES <br />3200 CEDAR STP[Ei, EVERETT, WA 98201 <br />425-e57-8810 — FAX 425-257•8857 — w�Nw.everettwa.org <br />APPLICATIONS ARE ACCEpTED FROM 8 AM 70 4 PM <br />PARCEL TAI( I.D. R <br />TRIICT OR SUBDIVISION I <br />NA6iTAT i�c� (-i cw�n,J �^1 32c�� ��oao�A-�l �� <br />7ENAHT NAME � � COHTACT FOR P R <br />N/A IMnr y ��A�s <br />CONTR.IICENSE� <br />ah �-�c�-! -{'�t (i <br />N IA <br />USE OF BUILDING <br />r <br />u�nnr <br />.��nol�om�sh �u�7N <br />J <br />NEATSOURCE <br />�C Electri��� Gas _ Olher <br />� �z/o� <br />P RMR � <br />- D7 <br />a�,oNe �47� <br />�820� Z�g-�z89 <br />,oroe qzs-.a5$-lo2$'j <br />MAILµT��'S`' ���t�tSnol+ �S�t•� <br />CONTRACT PRICE OF WORK <br />WORK !D�E�SCRIPTION I1 ¢ <br />'�' K��tI�Ei�tTtA� �1oMES �STIeUG.� to�J � C3'— IH�'F6 �E.�Qoo�� -` I_ <br />S- 3Foa����� �j1G�l�}- `%/ <br />... ........... � -----•--•�--- <br />NO. I TYPE OF FlXTLRE OR I1EM <br />Bathtub <br />Lavatory (wash basfn) <br />Shower (5-$E,�C'�o�-� Nri�lE) <br />Kitchen sink 8 disposal �/1C H NoME <br />Dishwasher <br />Clothes washar <br />Water healer <br />Sink (service/bar/mop/etc.) <br />Badcflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roal drains <br />Other <br />N0. I TYPE OF FlXTURE OR IiEM <br />A/C — nir haMling units <br />Forcad air systems <br />Gas piping <br />W ater heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiier <br />Re(rigeraHon <br />Woodstove <br />ome� <br />CRY OF EVERETT LOCAL 8ALE3 TA7( CODE 19 3705 <br />I hereby cedtity lhal I hava read and examined this applicaqon and know lho same to be true and cortecL All provisions ol laws and <br />ordinaces goveming Ihis type ol work will be compliad with whethar specified herein or not. The prantlng ol a permit does not presume <br />to give authority to Wolate or cancel the provision ol any other state or local law regulaHng construction or the peAamance of <br />construction. That I am authorized by the awner ot ihis properry to pertortr, the work for which applicaAon is made and I comply with the <br />State Conhactors Law 18.27 RCW and 296.200 WAC. i <br />t/ <br />Z <br />