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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREEI', EVERETT, WA 98201 <br />425-257-8810 — FAX 425•257-8857 <br />PG') �c�l�- p33 <br />S�TEII��(�g- �ll�� �i. ��!• I cc�i��l�mi� ��,o� I���M���-�;��� <br />LOT NO. i BLOCN TRACT <br />I� � �--c�hnJ�3eqR! �-S <br />ADDRE66 i1P PHUI�[ � � <br />1� �., ��1 �o S� wez �N�• s W� y, Srn���.�.eo, U)A e 9�� 9 � <br />N�/4 <br />COHTRACTOR <br />PHONE c � E <br />v <br />PROP09ED UBE OF BUILDINO <br />S. Fo �o <br />CONTRACT PRICE OF WORK <br />CONTACT NAME /� Z, �\ <br />>A�E � �+IslJ�G 734- 5t <br />ADDRE99 <br />Bulldlnp Mechenlc <br />PERMrt Combinal�on PWmbing <br />TYPE Demolillon � Sipn <br />SpdnkNr(Adheade) ____ <br />W011K DEBCRIPTION <br />� P�►N I ZSJ <br />NO.. I TYPE OF Flf(TURE OR REM <br />WATER CL03ET (TOILET) � <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKIN(3 FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTF�-� <br />SINK (SERVICEIBA7�MOf"F7C I <br />OTHER_____ _ _ _ <br />SAsi�--#t' ZZ <br />_� <br />PHONE <br />�X C f 7l. <br />S S, 3S'/ �543�, �sd -,z� <br />ZiP CONTR. UCENSE � <br />.o�PGi +f03 /✓Cs <br />E� P /d 2 3 <br />AAdlllan HEAT 60URCE <br />ARenllon � Elsclrk <br />Naw Oes <br />RepsldMslnt. Olhsr <br />LOCAL BALEB TAIf CODE IS ltOS <br />T'PL O� R%TUqH OF REM <br />!UC - A,'HANDLINO UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HE:ATEHS <br />CLOTHI:S DRVER <br />RANC3E HOOD <br />WATE:R HEATER <br />METAL FIREPLACE/STOVE <br />FIREPL 4CE INSERT <br />6AS I" If�f: PLACE <br />GA9 I1PN6E <br />GAS �'li'lIJO <br />[XFI�'J';1 FAN <br />OiNER <br />..... -•- <br />�,.iw:, <br />1 HEiiFBV CERITIFV THRT 1 HAVE �FAD ANfI FxAMRJEO THIS APPLICATION ANO KNON' TIIE BAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS ANC7 ORIIn1�AC[S d�)VERNIN6 THIS TVPE OF WORN WILL BE COMPLIED YVRM Y.'iETNER SPECIFIED MEREIN Oil <br />NOT. THE UfiANTING Of A PFFiM1T n0[S NOT PRESUME TO OIVE AUTNOF7ITV TO VIOUTE OR CANCEI THE PROVISION OF ANV OTHER <br />STATE OR LOCAL LAW REOULATIN(i CONSTRUCTIG.� OR THE PEAFOAMANCE OF CONSTRUC?ION. TNAT 1 AM AUTiORIZED 9V TIIE <br />OWNER OF THIS PROPEHTV TO PCRFORM THE WORK fOR WHICH APPLICATION IS MADF. ANU I COMPIV WITM TME 57A1E <br />COI�QA�PTORS LAW 18 27 RCW AND 288.200 WAC <br />� <br />