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� <br /> P�kRMiT Q►PPL��A�i I�(V � <br /> � CITY OF EVEREZ'f PERMI�' S�RVICES <br /> 3200 CEDAR STREE7, EVEqETT, 1NA 98201 <br />:: ` � ' 425-257-8910- FAX 420-257-8857 <br /> �o� �� ���� <br /> SITE ADDRFSS PApCEL TAX I.D. # ' PEFM11iT s � <br /> Cly3� / �� �i^ 0037d'7 GOz ;�o/ Cn c. oao�t-o�� <br /> LEGA LOTNO. BLOCK TRA�T �/` /'j� <br /> DESC. —� <br /> �J !J <br /> OWNER qDDRE55 7JP PHONE <br /> I��� F_����r;,�s �c. ��4�� � ��.r.r-�� �d"zc'3 yZ� �/� a �1'�f- <br /> TENANTNAME I CONTACTNAME PHONE <br /> CG;VTR�TOR ��DRESS ZIP CONTR.LICENSE q <br /> ►�� ��4..P,�;�,s .a-•-�� �� �3vT Jvo�� P�� ��r���:Jz <br /> PHONE <br /> `/�1' yZ z. 9J��1� �vc°.Y� (�L/� /� z�3 <br /> PRO�S��E OF BUILDING TYPElT � S�rmdkl1eon n � Sl9n binlga' In,�E �F�( Repa r/Maint. I HEA�011her�c <br /> ' C <br /> I i � <br /> �'`���'" ' CONTRPCI'PFICE OF WOflK C(TY OF EVERFTT'LOCAL SALES TA%CODF IS 3105 <br /> WORK DESCRIPTION <br /> ��IV�c,c� .�'�,� �''S�'� u21� <br /> 4 8���oo n F_�.�lA7�o�1 `�A� <br /> PLUP,IBING MECHANICAL <br /> NO. TYPE OF FIXTURE OF:ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET A/C—A/HANDLWG UNITS <br /> ,j' --�. � BATHTUB � FORCED AIR SYSTEMS <br /> �� LAVATOf'Y(WASH BASIN) __ HEAT PUMP <br />"�'� SHOWER UNITHEATEHS <br /> ,:;���' �. KITCHEN SINK 8 DISP03AL � CLOTHES DRYFR <br /> i � DISHWASHER / RANGE HOOD <br /> LAUNDRY TRAY _L WATER HEATER <br /> � CLOTHES6VASHER METAIFIREPLACE/STOVE <br />�°" URINAL FIREPLACE INSERT <br /> ,. li �. _ DRINKING FOUNTAIfJ / GAS FIR[PLACE <br /> ` � _ FLOOR DRAIN T GAS RANGE <br /> '. _ BACKFLOW PREVENTER � GAS PIPING <br /> � � SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br />�• � _ OTHER _ OTHER <br /> �I — — <br /> i — <br /> x; i — — — � <br /> ;�, I _ . <br /> ��1 �� I HERcBY CcRITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNIN3 THIS TYPE OF WORK WILL BE COIdPLIED WITH WHEfHER SPECIFIED HERERJ OR � <br /> �� �'�� • NOT. THE GRANTIi1G OF A PEHIdl7 DGES NOT PRESUAIE TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PFOVISION OF ANY OTHER � <br /> ' ��! STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORh1ANC[OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE ' <br /> �, � O OF THIS PROPERN TO PERFORM THE WOflK FOR WHICH APPLICATION IS lAADE AND I COMPLY WI?H THE STATE ' <br /> .,� ���. CO TR TOR B CW AND 296.200 WAC. I <br /> � � — ..�'�Cj-�..�JL �� fJ Z I <br /> � Si naWre of OwnedC ntractodAuthorized AgeN � Dale � <br /> I t Ii <br /> i <br /> . _—._. _.'_ - . _. . <br /> _ . _ . .�... y.Y kQi!..,� � <br /> � ��� � �-�:. . . ...: '.. ... �� t � <br /> fl <br /> � � �y¢.. �� �5 �4� � { <br /> \`� �,. •£NV� �;�� �y s�t: <br /> �4 <br /> ti� va <br /> \\4.. ��\ 'J _ <br />