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PERMIT APPLICATION
<br /> BUILDING I httEC HANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION
<br /> UETY OF EVERE?T PERMIT SERVt0E3
<br /> 3'00 CEDAR STREET,EL RETT.WA 3204
<br /> z`'3-25-25?-33f) ( FAX 423-25T-333T
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<br /> CONTACT
<br /> OWNER NAME: , a '
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<br /> CONTRACTOR PHONE:
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<br /> PRIMARY COINTACT: 0 OWNER '
<br /> CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> CONTACT PHONE:
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<br /> CONTACT EMAIL: * , A
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<br /> > iai Use of 3' in
<br /> Cs ntrar t Price of Work: `
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<br /> 4$330 iATED 6VIL7:tvi x PERMIT# ira?oli;a5i4 r :.. ..
<br /> � i `-jOr:LICA "t ' mss? i�yt� il'
<br /> t�of Prosect New� -_.. Addn AiteratietIP- P I!. tI I C 4G 1a �
<br /> # Repair Type eEProject: �Naw Addn� _Aiterat@ore _Repair
<br /> IMAft Handii ". 7=�r • , #of
<br /> Units Heat pump ltfatr
<br /> rarced fir ytei � Toilet
<br /> 'e°i it unimulaU,pit Heater Bathtub U Preventer t 'Id
<br /> Water Neater oiler Onnal
<br /> I of oath
<br /> am Gas i F@ ire �rT er tterl Clower Flortr@t in Fountain
<br /> alimmiw is }inert r Gran Ott.
<br /> t+ ht er,Ntki$a Otietiri� saTral
<br /> Cftshw�ashr Roof Drains
<br /> clothes
<br /> itatedia t Gas
<br /> samenn.#rv.xt Headart Farientsuminiminmeim NNW--n 41111111.111111111111.1111.11.111 { %etc.; Sts,r.,
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<br /> Chemical or Water iVccf Heads
<br /> ACKNOVVLECGEMENT.i have reviewed this aFpliceiicr srd ecr,ern:the inlcrmettcn ccrteired herein,is true end ccmect.MA'dere pursuert is this permit must c
<br /> current federal,state,and kcal law. The graritrg cf a permit crh
<br /> cir.ply
<br /> c u rentlcling Cleral, tate, n dek al zsd urdar ar. y authcdzes aFicrcyed wcrti end nc de afters therafrcm.Ceviattcns must first to suthenzed in writingfrc with
<br /> end t ccm t with the 8 f FCW ene2 I air,the menet,cr 1 an:auihcrized t the cwrar cf!his F�FetiY is perk=the wcrk kr which aFFlicallcr is n aria,
<br /> Ftali Cauthc icrs Lawurd rsivicircumstta circumstance.
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<br /> City
<br /> ' ' FERMI/#i' erE
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<br /> ,'a�dY'$rii utiicr@28d Age 'Signature 1 l L
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<br /> ' OtOviseci 6;013/2C-16)
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