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t0'd �tl101 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8957—www.everettwa.org <br /> I APPUCATIONS ARE ACCEPTED FROM B AM TO 4 PM � � --a3--�5 <br /> SITEADDRESS �✓ �ARCCLTAXI.D.N ���MI� — v4 <br /> l <br /> IEG�L LOTNO. BIOCK iRACT <br /> DESC. <br /> O �DR T'TP PHONE <br /> Di�vi n Ka,r�9�2 �sarne a� �o %tc )��5 � a�y -- i z-�r <br /> TGNANTNAME I CONfACTFORPERMfT � �MQN! <br /> fr � I � <br /> Nc�w�telr�tri�,�.l+ �L�� fA�'1110EC�. 1l011 l9e� stNE'�/Pqy�li►t�tv�i'I� wp 9'l�� <br /> `�N ViiErzHrrt ep�195�D/� 8-17 - 5 3/-�4�33 <br /> USE OF BUILbINO HBAT SOURCE CONTRACT PRICE OF WORK <br /> �{� ( �•j�l �„Q ( ,_Elechlc�Ges_Other I q 7 7 - �v <br /> WORK DESCRIPTION <br /> `��(,• l'VI 0 �.� ` I'�� �GC.G� f/tD l P�7 2� `� u. l i'L.s�C .� <br /> PLUMBING MECHANICAL <br /> i �IO. TYP[Of FIIfTUR[OR ITEM N0, TYPE OF N%TURE OR IT[M <br /> _ Tollet A/C—oirhendlinpunib <br /> Bathtub � FoNed air sy�l�ms <br /> Lava�ory(wash basin) �es piping <br /> Showor W�ror naacar <br /> Kil[hen�ink 8 dispocal Gac tlrplate <br /> Olshwachar Gee ronpe <br /> Cio�has wssnar _ Clothes drycr <br /> Laundry Vay Renpc hood <br /> Sink(aervioe/berlmoplelc.) Exhauct fan <br /> � BadcAo�vprevcntor H¢atpump <br /> _ Urinel � Unit haater <br /> DnnMng Fountein _ Boder <br /> Floar Eraln Rehipemlion <br /> � Greasc uap i Woodstovs <br /> ` Roofdralns Othar <br /> I Other <br /> CIIY OF E12RETT LOCAL BALE9 TA7(COO[If 7105 <br /> I heroDy ceNtNy that I have read and ezamined this eppGcaSon and knaw the ssm�to b�true anA correct. NI prwislone of IW�S�nC <br /> ordinaces poveminp thls rype of H�ork w9l be complied vnth whather specifad heraln ar not.The qrnnNnq of a pertnit dcea not praums <br /> to g�w authoriry to violnte or canwi N�provision af any other slata or loral law ropuletlnp corutrucdon or Me perfomona of <br /> consWqien.That I�m a zatl Dy tha ownor of thls pmperry M perform the�wrk tor which eppllcetlon is mad�anQ I comply wkh M� <br /> Stat�Cont!actorc 18.27 W a^• 295200 WAC. r, <br /> 11 �23 / U,S <br /> ure o •ner a ctor u enzetl agant Date <br /> � <br /> rC �rO'd i6r5 �Sa �9� £0:60 SD�Z—E2—nON <br />