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hllFt-2-�flll 1�:37 fF,OhL'C2.f1 HF_RTTNG 425-745-1,44 <br />Tu:ia�s2se�s� F:�'� <br />PEf�M�T APPLICATION <br />CITY OF kVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9P2U1 <br />�5-"'� 425-257-i3d10—FAX425•257-8857—�wm.everetlwa.org <br />�2U'� �'h�r�� j <br />'�� )�� � APPLICATIONS ARE ACCEPTED FROM II AA170 4 PM <br />SITE ADDRE55 r <br />LE� � T H GV <br />oesc.� <br />PARCGL TAX I.D. # <br />�'t� ini <br />pLOCK TRACT OR SUBDIVISION A <br />ADDRESS <br />� (',4�urcl� 72ob 61�r�� <br />ICONTAC7 FOR PEflA1R <br />1�_hf7i�2 <br />�—rirnnncTOH L I�-41J E3 <br />Cm Ut-�,�}i n c- I►� <br />COtITR. LICENSE # _ . ,. ,., _� ..., � n� i <br />USE OF 9UILDING <br />PERMIT # � C <br />�� � � (' i^ � - � -' <br />. a '4Z57 �I <br />�p j1U E <br />��$Zp�j _ <br />�i' P�JZ� fC �O6 W <br />�.i�rvur .-nv�.c <br />6�er�.� q gZo I 4-z5 Z5�1 �� � 6 <br />HFAT SOURCE ! CON7RACT PRICC OF wonK <br />,a,LElectric _Gas_Oth��er I �j�� � <br />VlORK OESCRIPTION <br />I�s%�i '� i��1 Pa�1C��c�e h�a`� PVM..p <br />NO. I TYPE OF FlXTURE OR ITE-h1 <br />Toi�et <br />^ Bathtub <br />_ Lavatory (�vash basin) <br />Showor <br />I<cchen sink & di,posal <br />� Dl;mva5hcr <br />Clothes washer <br />� Waterheater <br />-� Slnk (service�barlmcpletc.) <br />^ Dackliovr preventer <br />Urin01 <br />^� Drinking Fountain <br />Floor dra�n <br />^— GfeflS' lf3p <br />Roo1 drains <br />—_ Olhe� <br />h1ECHANICAL <br />N0. I TYPE OF FlXTURE OR ITE11 <br />A/C - air handlin0 units <br />Forced air syslems <br />� Ga; piping <br />YJaier heater <br />Gas fireplace <br />Gss range <br />Giotnos dryer <br />� Ranpe hood <br />Exhaustlan <br />� Heai pump <br />Unit heater <br />BGi;ar <br />R 'frigeratipn <br />� �Noodstove <br />Other <br />CITY OF EVEREiT LOCAL SAL[37A%CODE IS 9105 <br />I hereby cer0lfy that I have read and examined this appl'�catlon and know the same Io be true and correcL All provisions o( la�vs and <br />ord�nacc^, goveming th o type o1 work tvlll be complied wilh �vhelher specified herein or not. The granting of a permit dacs not presume <br />to pive aUthoriry to vfciate or cantel the provision of any other stale or local �av+regulating construclion or {he p2do�nance o( <br />construe�lon. Thal I am autho�ized by t.�e avner of this property to perlorm the work lor �tiiiich application is made and I comply with lhe <br />Statc Coniractors Law 18�?ZRCW and 296200 WAC. <br />.� . . � � J _ 7 /1 1 1 <br />� <br />