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� <br />� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everellwa.org <br />SITE ADDRE83 <br />�(o17. ��¢fG� �JC . <br />LE LOT N0. <br />��. � /,, � a�ao <br />�(CTG�i !l. VG(N <br />�Theres� A. L <br />SAME k5 cwrliEil <br />LHndw�a�k Eniu�Pr�s�s <br />coNrn. uce� e l� AN p <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 6�(—/(� <br />PARCEL TAX I.D. N ��T � <br />Dbb v SOoo�}oo O) 005- <br />e�ocK rn�cronaueoma�on. <br />�- e�a1 a„A 1:� 'eld's F,�s� Al�k;o,�.�i'if; Ve, <br />ADD —� (F�R€ �I2��2�� <br />e �3��2 F�.,ral �e. �v�t�1� WIA�g�I <br />�_J.. <br />GONTACT FOR PEI <br />fef�r Vwl,a <br />(nc, P.o. <br />ME► iy'OMU <br />U8E OF BUILDING I <br />`Pr, «w..-� R�s. A.�.�.�.�— <br />�cr� S�.$S Bc <br />�/%l� / <br />HEATSOURCE <br />_ EkcUic � Gas _ Other <br />rHONE H z5 - <br />�...�� l�G'hM <br />zz� <br />'{ Sf�O <br />,a�s �Eb93 <br />CONTRACT PRICE OF WORK <br />� 2�,000 (p�'�2; <br />WORKDE8CRIPTION:'BatiStrhe� Rew.�de� �.�nc�u�...� ra�a� �onE�.roe�••- wn���h�� <br />�F s�a� w.�l, G�l,..J �l�.ck�<.:� w�F�eks ....1 1:.�L.�:..� R�l/�ei,�g 3 w�n�o��w5. <br />NO. I TYPE OF FlXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen aink 8 disposal <br />Diahwasher <br />Cbthes washer <br />Water Mater <br />Sink (servioelbadmop/etc.) <br />Badcflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof draine <br />Other <br />NO. I TYPE OF FIXTURE OR ROI <br />AIC - air hardlinp units <br />Forced air ayetems <br />Gae PW��9 <br />Weter heater <br />Gas fireplece <br />Gen rarpe <br />Clothas dryer <br />Ranpe hood <br />E�auat fan <br />Heatpump <br />UnR heator <br />Boikr <br />Refriparation <br />Woodstove <br />OVier <br />arr oF �rt�rr �oca s�uea rnx cooE �a a�os <br />2 <br />I hereby certiry thet I Aave read end ezamined this epplica6on and kraw the eartre M be tiue end conect. All provisbns of lawa and . <br />ordinancea goveming this type of work will be oomplied with vAieNier spedfied herefn or not The prantlnp oi e pertnit does not piesume <br />to gfve authority to violale or cencel the provlsion of any other atate or local law regulatlrg oonsWClon a the perfortnanoe ef <br />con�u dwn. Thp� I am authorized by the owner of thia property to peAam the woilc for which epplicatbn ia made and I oortply wNh ths <br />StA[e �ordryctp�s lav+ 18.27 RCW and 296.200 WAC. <br />j -20 -2rJ� O <br />L�� <br />IZMS� <br />