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�-ERMIT APPLICATIJN <br /> CITY OF EVERETT pERMIT SERVICES <br /> 3200 CEDAR STHEET, EVERET�, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 I/ <br /> T� _ ��� <br /> SITE ADDRESS PARCEL TAX I.D.N O/O PERMI7 K <br /> 2 (4' c��9 �-c_S � 3 / �o a� c� 3o3-ooz. <br /> LE6A LOT NO. BLOCK TRACT <br /> DESC. �' G �S 7!� /� �/ <br /> OWNER � 7 �a <br /> A�DRESS LP PHONE <br /> __l,✓� ��r.� M ��S�-� ��o A � �y � c �� � O���e��r 9-fS2�3 <br /> TENANTNAME I CONTACTNAME PMONE <br /> �v� � <br /> CONTRACTOR ADDRESS ZIP CONTR.4CENSE M <br /> PHONE ✓J �!� q �G � � ,e� ! <br /> � / � �l <br /> PROaOSED USE OF BUILDING Building D Mechanical Additlon HEAT SOURCE <br /> PER611T � COmbinetion u Plumbing WORK � Alteretlon E�ectric <br /> 5 TYPE Demolition U Sign TYPE New �Gas <br /> � �/ e.— Sprinkler(N of heads) Repair/Maint. Other <br /> CONTRACT PRICE OF WORK 'CITY OF EVERETT LOCAL SALES TAI(CODE IS 3105 <br /> WOHKDESCRIPTION � ��-L 0� �,y�`ry� 9 GL y /�� ��. <br /> �'e'Q'�C.IC / /J <br /> x .�I,�css <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUqE OR ITEM N0. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSE7(TOILET) A/C—A/HANDLING UNITS <br /> � BATHTUB � FORCED AIR SYSTEMS (y�-9� <br /> _� LAVATORY(WASH BASIN) _ HEAT PUMP O <br /> SHOWER UNIT HEATERS <br /> Z KITCHEN SINK 8 DISPOSAL Z CLOTHES DRYER <br /> _ DISHWASHEFi RANGE HOOD <br /> LAUNDRY TRAY Z WqTER HEATER <br /> _L CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRtNKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS HANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BARIMOP/ETC.) Z EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERIT'FY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br /> PROVISIONS OF L4WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER 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 FEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> Signatu` re o7pwneU� dAuthonze gent Date <br />