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fram: <br />03/��i2010 11:45 tl550 P.002/GD3 <br />PEI�MIT APPLICATION <br />�ITY OF EVERETT PERMIT SERVECES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — nnvw.everettwa.org <br />APPLIl;A710NS ARE ACCEPTED FROM 8 AM T4 4;�M <br />SITE ADDflE.iS PARCEL TA% I.D. p <br />`-7�o LuDc—r� -�T��r <br />LEGA LOT NO. BLOCK TRACT OP SUBDIVISION p <br />�ESC. <br />O W 11ER AD�F [SS CITYfLIP <br />�'V�,��Tr f�vus�in�� �`/crn(���7� - 27iS /g'�'.r/.r�� • �V� <br />!i�', /NG <br />CONTH. LICENSE p�M f{_L' Z�` � B` � <br />USH OF BUILDING <br />TACT FOR PEHMIT PHONE <br />HEAT SOURCE <br />��Electric ✓Gas Olhor <br />E-MAIL <br />�.va•7 <br />PEflMIT p <br />� IC,ci3 o/'-I <br />iDNE <br />`d7,5'-�3 -�/� y <br />iotT��b � <br />yL� �°/� <br />CONTRACT PRICE OF WORK <br />WORK �ESCRIPTION //j�'�/y�/�, /�.�yJ LJ—^�-CJ' S�flc,YVl� � PrUV/L� �V`E�-..% C-0PF�� , <br />/�A./L–S �D Q �(. � Jc�/-a.f��s � S.E6 I9 :'TY1crl�� CU�j' U�• ,.S�U�E' U/." �,(/o ,2G �Ji'�r-J � f .;�� <br />NO. <br />� <br />TYPE OF FlXTUIiE OR ITEM <br />Toilel <br />BathWb <br />Levulory (wash basin) <br />Showor <br />Kitchon sink 8 dispasol <br />Dishwbsher <br />Clolhos washer <br />Waior healer <br />Sink (servicclbar/mop/etc.) <br />Backllow prwonter <br />Udnal <br />Drinkinp Founlain <br />Floor drain <br />Gronsa Irap <br />Rool drains <br />Olher <br />NO. I 7YPE OF FIXTURE OA ITEM <br />A/G – air handling units <br />Forced air syslems <br />Gas piping � <br />We�cr healcr <br />Gas lireplace <br />Gas range <br />Clot�es dryer <br />Range I�oad <br />Exhaustlan <br />Heat pump <br />Unit heater <br />Boiler <br />Relriperation <br />Woodslove <br />Other <br />CITY OF EVERETf� LOCAL SALES TA7( COOE 19 3105 <br />I here6y cerilily thal I have read and examinod thls application and know lhe same lo be Irue and correcl. All provisions ol laws and <br />ordinaces governin�t Ihis rype ol work will be complied wlth whether specilled herein or not. The gianting ol a permit does not pmsume <br />lo qive aulhorify to viotate or cancel the provision ol any olher slate or local law repulalinp conslruclion or Ihe pertormance ol <br />construr.tion. Thet I am authorized by lha owner ol Ihi, proporty lo perform lLe work lor whieh epplicalion is roade and I compty wiSh the <br />S(ale Conlractors,60w 18:z9ACW and 296.200 WAC. <br />