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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.ev,-,rettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />SITE ADDRESS 5v Ik c 31 <br />PARCEL TAX I.D. # <br />PERMITW <br />Y)5 SE Evcnrt N1n11 WNy <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />W 1/4 O �- ScCtiUrx i'a, T•uinShiP 7.'s lv , tbr,y� 5 LuSi •o4-M <br />OWNER ADDRESS CITY/ZIP PHONE <br />y Pt'. <br />a519 oor,A-t <br />W cct c�,s� RT P izo , i nc. r00.11C.14k.K1. C A <br />793-1510 <br />9'i6ll (y15) <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Pic.l ATo.blc Pizw <br />E\jAN (-Lot.)z3Q.-"`t3cA <br />_ v u.9 <br />-- �T�s <br />CONTRACTOR l-4MS-T'S, 5,�,. ADDRESS CITY/ZIP PHONE fir- <br />-71431- SU L 1th St . Mcrcrc =t(aw c1 <br />CONTR. LICENSE# Ud p* d aOLAQ C zW)2.36-9y <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�2.2u. kR-1uil r+.r t' <br />Electric X Gas Othr <br />Z.4jO, CCl� <br />WORK DESCRIPTION <br />UuiA out \J"Ce Vvk- TaSo(-e Ffzza (Zect�w�'cvnE. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />3 <br />Toilet <br />A/C - airhandlingunits <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />�I`tchen sink & disposal <br />Water healer <br />Gas fireplace <br />!_ <br />\Dishwasher <br />Gas ranae <br />Cloth s washer <br />Lau r4,tray <br />` <br />Clothes dryer <br />Range hood <br />_ <br />_ <br />Sink (s a/bar/mop/etc.) <br />Backflow enter <br />Exhaust fan <br />Heat puma <br />l <br />_ <br />Urinal <br />Drinking Founla <br />_ <br />Unit heat r <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />l <br />Grease trap <br />Woodstove <br />=Roof <br />drains \ <br />Other \ <br />=Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State ntrectors 27 RCW and 296.200 WAC. <br />34, (06 <br />Signature of Owner/Contractor/Authorized Agent Date ' j/ <br />