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P��RMIT APPLICATIC►�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR �TREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org � `g`6� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT M <br /> 103i5 19Th Ave, 5 • E • Oo545500000600 �(� - � <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> I`�lffR L7eva6c��+e..i 67a5 �16�h I�ve . fv.E_ '� �oo Kikkln�d 98033 4a5 •Sa�-Yy� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> OR. �Anc� pe,.�ol � (�isio� fl � Pne �f in-�on 360 - 65 � • 7�oi <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �M � ih FiRe SyS� en+ S <br /> CONTR.LICENSE# <br /> Sw�T�r�.} FS 136oT 3813 168" 5f, N• E. j � � AQ/���.�-l0 .. , 9�a�3 360-65�� � �01 <br /> USE OF BUILDING HEA�SOURCE� CONTRACT PRICE OF WORK <br /> �en-1.� I . C� ' • _Electric _Gas_Other I� ,F ' <br /> � � s�a� � .., � Zbo <br /> WORK DESCRIPTION <br /> Add � 9 1-lead � -+� Pcco.tic�d�� � T,e..a.,t ��..Pri��c�.�.r� -} . <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OP FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> BackFlow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3t05 <br /> I hereby ceriti(y lhat I have read and examined this application and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specifled herein or not.The granting of a permit does not presume <br /> to give authonty to violale or cancei the provision of any other stale or local law regulating construction or the perfortnance of <br /> construction.That I am authorized by the owner o(this property to per(orm the work for which application is made and I comply with the <br /> Stale Contraclors Law 18.27 RCV�'and 296.200 WAC. <br /> � ..,�..� /1�u..-�.,,. 6 - 4� • 0 5 <br /> Signature of Owne ContraclodAuthorized Agent Date <br />