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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT, WA 982G1, 425-257-8810 <br /> SITE ADDRESS PARCEL TAX I.D.M nPERMIT# <br /> :Z�2 GRhNb AJ�n1�lE �JF�tET N39 ( - `l$3 -921 - 0002 1`j �.��� '��l <br /> DESCLLOT 0.2Z B�OCK TRACT � �u�5 PGC 3y S�C��+�t� <br /> � I '��' Plaf ��'E�ere{t- Vol. 3 0 �, <br /> OWNER '�a���� L- ����d�� i ADDRESS ; PHONE <br /> S�z4.,.,� �J K�rr ; Sa�v�e ;�(is-zsg-9611 <br /> TENANTNAME CONTACTNAME ; PHONE <br /> — I 17aJ �� L. �rd� ; +�Zti ' 303 - 8608 <br /> CONTRACTOR S�I.� ADDRESS ! CONTR. LICENSE k <br /> � G tlne- ! <br /> PHONE .�L5-363 - t��,o �'s `� <br /> PFiOPOSED USE OF BUILDING Building � Mechanical Addition HEAT SOURCE <br /> SI�� 1e ���`� PERMIT �Combination Plumbing WORK � Alteration D_Electric <br /> `^�! TYPE Demolition Sign TYPE New <br /> �LGas <br /> ` S�rinkler Repair'Maim. �� Oiher <br /> R.�s c�e� �_ <br /> CONTRACT PRICE OF WORK � 7 f�pO • O p CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION aep1��� (��151 (,,�� „O�,rn�� Oy� T0� �� O�r <br /> v,i;�l� 0 51ne �� o�r�e� �o A�.� I�.eo-� ro o vv� . <br /> PLUMBING MEGHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OH ITEM <br /> WATERCLOSET _ A!C—PJHANDLINGUNITS <br /> B,ATHTUB _ FONCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ fiEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> i,LOTHES WASHEN _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENiER _ GAS PIPING <br /> SINK(SERVICE�BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> II HEREBY CEFITIFY THAT I HAVE READ AND EXAh1WED 1HIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � pFOVIS10NS OF IAWS AND ORIDINACES GOVERNING THIS TYPG OF WORK WILL BE COAIPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> , NOT. THE GRFNTING OF A PERMIT DOES NOT PRESUh1E TO GIVE AUTHORITV TO VIOLATE OR CPNCEL THE PROVISIOW OF ANY OTHEF I <br /> i STATE OR LOCAL LA'+V REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTIOtv. THAT I AM AUTHORIZED BY THE <br /> , OWNER OF HIS PROPERTV TO P FFOR1.1 THE WORK FOR WHICH APPLICATION!S MADE AND I COMPLY WITH THE STATE <br /> ' CONTRA S LAW . 7 RCW ND 29 200 WAC. <br /> ! � 2 0 � �� <br /> Signawre o Owner/Contracro Authont d Agent Date ; <br /> :,� �. <br />