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( <br /> �� PERMIT APPLICATfON <br /> � CITY OF EVEFtFTT PERMfT SERVICES <br /> i 3200 CEDAR S f REET, EVERE�, !';!, P�'2^t <br /> 425-257-8610- FAX 425-'_�--�°-' <br /> SITE A�9R1 SS i..� \��� C • , • (� R�yTA;<'��0�-�\�\ P(�✓✓I C/./Z <br /> `" lG V \,\S i <br /> LFGA LOTNO. BL�O K TflACT 1 /� <br /> DESC. �1 � L-.�C'lf�NS('�GfLR�/ L' SIT�'rL� <br /> OWNEfi ADDRESS l 71P PHONE <br /> C o�a C 2cck � �NL. � I 910 5����-rc SPa.,Nc>s '�r. i- , ~,�,��;�o0'u, 1n�A. `I6� 9 Z <br /> TENANT NAME CONTACT NAME �_c) �H� PHON�CLL <br /> (� �f�i l7rM!�2iD�.� : . • �`,'_5, :39-5y3� , sao -�9Zv <br /> CONTRACTOR qDDRESS Z1P CONTR.LICENSEN <br /> � PNONE SA�"` E GO�-DG/� C?C)I✓C� <br /> j L'�F iD/ LZ� G 3 <br /> PROPOSED USE OF BL'ILDING uilding Mechanical Addition• HEAT SOURCE <br /> � J �U � O PERMIT Combination Pl�mbing WORK Alteretion Electric �, <br /> �I� TYPE Dem0lition �Si n TYPE �New �Gas <br /> .. Sprinkler(n ol heatls) Repeir/A7oinL Other i <br /> CONTRA,T PAICE OF WORK � I CITY OF EVERE77 LOCAL SALES TAX CODE IS 3105 � <br /> WORK D(ESCRIPTION - • <br /> (�l. A� �Z.�O to <br /> ��_�Asr � � � y � <br /> PLUMBING MECHANICAL <br /> N0. I TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR ITEM <br /> � WATER:LOSET(TOILET) _ WC-A/HANDLING UNITS . <br /> Z 8.4THTUB FORCED AIR SYStEMS <br /> Z LAVATORY(WASH BASIN) HEAT PUPAP • � <br /> SHOWER UNIT HEATERS <br /> � KiTCHEN SINK& DISPOSAL � CLOTHES DRYER <br /> �_ DISHWASHER RANGE HOOD - I <br /> LAUNDRY TRAY � WATER HEATER ' <br /> 4 CLOTHES WASHER METAL FIREPLACE/STOVE <br /> JRINA� FIREPLACEINSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN � GAS FiANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAF/MOP/ETC.) � EXHAUST FAN <br /> _ OTHER _ OTHER OZq i <br /> — — ��� ; <br /> ��V� I <br /> I HEREBI'CEflITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATIO�AND KNOW THE SA�dE 70 BE TRUE AND CORRECT. ALL i <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS T1'PE 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 REGULATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE i <br /> ON'NcR OF THIS PROPERN TO PERFORA4 THE WORK FOF INHICH APPLICATIOIJ IS MADE AND I COMPLY WITH THE STATE <br /> CONTRpEiORS LAW 18.27 RCW AND 290.20014�AC. <br /> /. ��^� ��-,.�� 1� I �:,^ 3 <br /> Signature o' Owner/Contractcr/Authonzed Agent ate � <br /> 1Z � <br /> �— _ <br />