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----------- <br />PLRMIT APPLICATION <br />oo:, CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 4 25-257-8857 <br />SITE ADDRESS [� PARCEL TAX I.D. B PERMIT . <br />Res- Ro-11, J(JJ . .5co 1123_ur>n On `I-_c'n_vs� sda <br />LEGA LOT NO. BLOCK TRACT <br />DESC. /_41 !I e1 rA i/ / /r .r r / ra / r r l On nit <br />;alf t'62 7od5 „ds l' L RL 8U T S7r s�i �V f/P MO0 ? - 6/15)337.2 <br />TENANT NAME I I CONTACT NAME t PHONE <br />Ssorny' 10//rj yn--, t ("1-75' 33_; Ud <br />CONTRACTOR A�D(D\REESS/ /� y ZIP CONTR. LICENSE 0 <br />PHONE <br />PROPOSED USE OF BUILDING Building Fl Mechanical I Addition I HEAT SOURCE <br />lT7lC �j ST PERMIT R Combination Plumbing Plumbing WORK R Altemlion I� Electric <br />Demolition Sign TYPE B New lFHJY Gas <br />Sprinkler Ro^atrddaint other <br />RA T PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />l' <br />WORK DESCRIPTION / <br />s,yh <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />. _ <br />_ <br />_ <br />A/C — NHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PEfjM1T DO S NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REG)KATING NSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPR rTO P FORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LA1y'1 g27 RCW D 296.200WAC. <br />216 /O <br />nnupt W 'Auum Unit? L 1 I/r'r� <br />, ,a <br />