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P�RMIT APPLICA <br />EVERETT PERMIT SERVICES <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (sen�icalbar/moplcic.) <br />Backflov+ preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />��.-: �,>%� �i :%:s I <br />CONTRACT PRICE OF WORK <br />� <br />wc — av nandung unns <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas ran9e <br />Cbthes dryer <br />Ranc�e hood <br />Exhausl fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Olher <br />I hereby ceritify tha� I have read and examined this application and know the same to be lrue and correct. All provisions o( laws and <br />ordinaces goveminc7 Ihis type ol wm k�vill br, complied wilh whelher specifieA herein or not. The 9ranting of a permit does not presume <br />lo give authority to violate or cancel lhe provision of any o0ier state or local law regulatinc� conslruction or lhe peAormance of <br />construction. That I am authorized by lhe owner of this property lo perform the work (or �vhich applicalion is made and I comply with Ihe <br />Stale Contryclors Law 18.27 RCW and 296.200 WAC. <br />�/ � ! ` /^, r '� L � - ' , — / ` <br />Sighature o( OwnedConVacl�orlAuthorized Agent Dale <br />