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PERMIT APPLICAT�ON <br /> CITY OF �VERETT PERMlT SERVICES <br /> 320U CEDAR STREET, EVERETT, WA 9l3201 <br /> 425-257-8B10— FAX 425-257-8135� , <br /> SITE ADDRESS � PARCEL TAX I.D.q ' PERM�T a <br /> �� �- �.�" 1� ^i���� � )1�. 1��` ` ����.'�� 1���`�2i'�'���. Il�''�����[�'� 3�_ <br /> IEGA LOTNO. BLOCK TRACT <br /> oesc. �, ,� �.-� c[�hJ��Eti �.:�T741� <br /> , <br /> OWNER ADDRE55 y 21P P40NE <br /> Co�o Gv�c, �r��. , I Q le S���eZ �N�,s WA y � �-�A.��.�000, GJ�}, 9 �� 9 Z_ <br /> TENANTNAME CONTACTNAME /�.Z�\ ��PHONE Ctu- <br /> L J <br /> N�A� 'pA�E' L7R-1/�l3�.0 37�W-� 59 3 S 359 �Sti3�, 330 z� <br /> CONTRACTOR . ADDRESS � � ; ZIP CONTR.LICENSE R � <br /> i I <br /> rrtoNe J lkw.E �E�Xl� /�/�3 C� � <br /> � <br /> PROPOSED USE OF Bl11LDING Building � Mechsnical P.ddition HEAT SDURCE <br /> PERMIT � Combinalian Plumbing . WORK � Alloretlon � Electdc <br /> S 0 �O 9 O TYPE Den101itia� Sign TYPE New Gos <br /> ��— Sprink�er(q ol haads) I RepaidMeint. Othor <br /> CONTRACT PRICE OF 1YORK CITY OF EVERE"ff LUCAL SALES TAX CODE IS 3795 <br /> WORK DESCRIP'T10N <br /> P� n� 123 � � <br /> L'�r�s� � 21 � � I <br /> I <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPf: (?F FIXTURE OR ITEM <br /> � WATER CLOSET(TOILET) A/L'-A;FIANDLING U,�ITS i <br /> �_ BATl�iTUB �_ FOIlC�')AI!� SYSTEMS <br /> � LAVATORY(WASH BASIII) _ HGAT PUMP <br /> SIiOWER UNIT H:_ATERS <br /> � KITCHEN SINK&DISPOSAL 1 CLOTH[5 DRYER <br /> _�_ DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> ORINKING FOUNTAIN GAS �IftEPLACE <br /> FLOOR DRAIN GAS R�NGE <br /> B�CKFLOW PREVENTER GAS PIF'INQ <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTIiER OTHER <br />� I HERE�'!CERI7IFY THAT I hIAVE READ AND EXAMINED TH�S APPLICATION ANO KNOW THE S�tdE TO BE TRUE AND CORRECT. ALl <br /> I PROVISIONS OF I1�WS AND OfiIDINACES GOVERNING THIS TYPE OF WORK WII L BE COMPL.IED WITH WHETHER SPECIFIEP fiEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTIIER <br /> Sl'ATE OA LOCAL LAW REGUL�T�NG CONSTRUCTION OR THF PERFORMANCE O�CONSTR:JCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO P[RFORM THE 4VORK FOR WHICH APPLICATION IS MADF O�ND I COMPLY WITH THE STATE <br /> CO � RS L/A�W 18.27 RCW ANO 296.2W bVAC. <br /> �GV't �N .� 't..�! ���4 �� <br /> SignpWre ol UwnedConlraclodAi.ithorvrd Ayent lo � <br /> L� --�---------- ��----.__._ _.. _._ /Z I <br />