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�- P�RMIT APPLICATION <br /> C1TY OF EVERFTT PERh11T SERVICES <br /> 3200 CEDAR Sl REET, EVERE i7', `NA 98201 <br /> 425-257-881 Q - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.��.N PE. I7 x <br /> .1-41I �QOA I �,�����2�0 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDflESS ZIP PHONE <br /> 1 V P � �S�` � 3 a.� ►3eo a�r� <br /> TENANTNAME CONTACTY ME PHONE <br /> E n rx��Q.�.ss5 cufiC � 5cr�2y oa�z ��� ya-5-��w-SS�r � <br /> COI�TRACTOR AODRES.�'i ZIP CONTR.LICENSE N <br /> Ucympy� Mc�c.Hr�NicaL Pv. Ro� s��.V �yawwo��u.w9d��� p�y�mpmr�7oo/ <br /> PHONE <br /> y�''7�� �8�� � — <br /> PROPOSED USE OF BUILOtNG Building � Mechenical Addition HEAT SOUFCE <br /> PERMIT Combination Plumbing WORK � Alteralion � Electric <br /> TYPE Demoiilion Sign TYPE New Gas <br /> �=-K;�RL'SS LU�jCr Sprinkler RepaiNMeint. O�her <br /> CONTRACT PRICE OF WORK u� CITY OF EVERETT LOCAL SALES TA%COUE IS 3105 <br /> la�DOV <br /> WORK DESCRIPTION <br /> ,VJ /0� z�(o <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF Fi.tTURE OR ITEM <br /> WATER CLOSET 1 A/C–A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> i SHOWEii _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASFIER METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FL00�1 DFiAIN GAS RANGE <br /> BACKFLOVi PREVENTER _L GAS PIPING <br /> SINK(SEF'JIC6'8AR/MOP/ETC.) ,3 EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIfY TNAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND COARECT. ALL <br /> PROVISIONS OF IAWS AND ORIDIM1ACES GOVERNING TH�S TYPE OF WORK WILL BE COMPlIEO WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOF!MANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHILH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> GONT TOFiS LAW 18.27 RCW AND 296.200 WAC. <br /> l I U !� � <br /> Sign re of Ow r/Contracto uthorized Agent ate �/l <br /> � <br />