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�8/13/2609 14:57 2067821303 OLSON ENERGY PAGE E2/02 <br />� ______^E. . . <br />PERMIT APPLiCkT10N <br />CITY OF EVERETT PERMIT �ERVICES <br />3200 CEpAR STREET, EVERETf, �NA 9820� <br />425-257-6810 — FAX 425-257-8857 — www.everettwa.orq <br />APPLICATIONS ARE ACC6pTED FROM 8 AM TG 4 PM <br />31iE A�DRESS <br />1203 M �kD2Un!/} �WG. <br />LOTNO. I BLOCK <br />DE$C, <br />pAjiCEL TAX 1.�.1t <br />OO;�O � -�,�Ova I'I �.� <br />TRAC7 <br />___..___ _....�.� <br />��S � N, 'LL El� � 2� 3 M q� � oN� ;�/G. <br />7eNqNTNAME � CONTACTFORPERMR <br />�8 -a3 <br />W/k y R <br />I L� I L- �t�l CN �N D GL 20 (0 78 Z� 522.- <br />GON7i2ACTOR ADDRE55 CITY?JP PHONE <br />I��SoN ��vc_�L� y s�r�-vr cr 4415 ���vJA-y N kl �} wl{- '�R I o`7 <br />cUNL�ONES9S lt-3 l0/�p�__ �, 2d(o %82-55Z2 <br />us[ oF sui�omic <br />S��JIa �-� �� M �L <br />WORK �ESCRIPTION <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />� Bathlub <br />Lav�atory (wssh basin) <br />� Shower <br />Klmhen sink 8 disposal <br />Dishwasher <br />Clelhes vr.isher <br />� Laundry Uay <br />Sink (servir.a/69Nmop/otc.) <br />/ 6ack11�w �reven[er <br />� Urinal <br />�dnkinA Foun4iin <br />Floor dnin <br />_ Greaso trep <br />Roof drainc <br />� Other _ W�ftE� ft&7�Pt/L <br />- �--�-�� � .HBATSOURCE <br />_ Elaetic ✓Gas _ O�ha� <br />CONTRACT PRICE OF W( �,K <br />� ��i��ao� <br />NO. � rypE OF FIX7URE OR fTEM <br />w� — air nnnqliny unils <br />_ y <br />� fbrcedairsystert�., <br />Gas piping <br />VJak r heater <br />Gasfireplace <br />Gac ranga <br />Clathoa dryor <br />Rengehood <br />` Erhaust F;n <br />Heat pump <br />_, Unitheater <br />� 8ailer <br />__ Rafrigeration <br />WoodcWve <br />^ orher <br />CITY OF EVEREI7 LOCAL SALES TN( CODE IS 9106 <br />I horeby cotltlfy that 1 hnvp read and nxami�ed lhis appllCflGon and know the samo m be hue and col'nx;t All provigians of laws and <br />orclinaces govoming fhis type of work will bo compliad vnth v,�hether spnci�ad herein or not Tho granting o( a permit doos not pfesume <br />to glw authonty to violeh: or cancnl the provieion ot any othar;talc orloral law regula6ng constructian or tha parfortnp�Co of <br />tonsW ct�on. That I am autbonzed hy lhe owner of this property to per!ortn the wptk for which application is mndo arr] t enmpiy with tlia <br />�S�tu C lradnrs Law iB.Ti RCW and 29G200 WAC. <br />�-���' _ __ rlj 3 /� � <br />