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( <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 42�257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM / �� �%� <br />���� <br />�3�� w��k�h� Bl�� <br />LE LOTNO. BLOCK <br />coNtx. uceHse t � �� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />0 <br />IPARCEL TAX I.D. t PERMIT k <br />005a5"jOC(700�i� MIIUI-��� <br />7RACT OR 6UBDMEIDN * <br />App�SS d P PHONE � <br />— 131b V►'1o141r� BI�� ,�ll��e71; 9�2a3 4� <br />COHTACTFORPERMT PHONE <br />EilA1L <br />��.n�� <br />SUt� E IM�4I�1 3i <br />��i� INlc�1t'�� <br />I HtATSOURCE <br />I �Eioaric _ G:w _ Other <br />i�'''^ P <br />NO. I 7YPE OF FlXTURE OR ITEM <br />Talet <br />Balhlub <br />lavatory (wash basin) <br />Showcr <br />Kitchen s�nK 8 disposal <br />Dishwesher <br />ClWtws washer <br />Welcr hea:er <br />Sink (sC vicelbarlmopletcJ <br />BackP�+a preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Root dralns <br />Other <br />W��,�r r�,�.� �,�?�y_ <br />��i� ��2-]Z 73e.6 <br />CONTRACT PRICE OF WORK <br />� n .. �.. .�.- <br />�.t9�i1 `� 0 c�i`c� ��4-w��- Co �� � <br /><��+�3�� ��i �l <br />� � ��� <br />IiO. <br />TYPE OF flXTURE OR IiEM _ <br />A/C — alr nandling unRs <br />Forced air systems <br />Gas piping <br />Watar heater <br />Gas fireplace <br />Gasrange <br />Cldhes dryer <br />Range hood <br />Exhawt fan <br />Heat pump <br />Unit AeAtx <br />Bater <br />Rehigerafi0n <br />Woodslove <br />CITY OF EVEREIT LOCAI. 9ALES 7/Jl CODE IS ]105 <br />I hereby certity that I have read and examined this applicatlon aM know the same ta be true and correct All provisions oF laws and <br />ordinnnees gOveming Uiis type of work will be tomplied with wheMer spEcified herein or not Tha grantlng of a pertnit dc.ts not p; esume <br />to give auGarity to violate a u�ncel the provision of any other state a local laW regulatlng conSUuctpn or tha perfortnance ot <br />constniction. That I am aulherizcN! by the owner of this property to perform the work for which applica0on is msdB aftd I compty wilh Me <br />SlaleLontraqCrs Law 1Fi,27 R'.:I�Land 29G.200 WAC. <br />� �� Sa« ��>> wd�o�a< <<�z �a� ��°r <br />