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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.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />63 St SV- <br />PARCEL TAX I.D. # <br />C�0 ' 5317 - VLrz <br />PERMIT # <br />i rd <br />-02 - <br />LEGA LOT N9. <br />DESC. � <br />BLOCK <br />TRACT C 1 � � /�-r _ <br />J 1 I V R 1 Pc A r ssou 0 <br />OWNER ADDRESS CI1Y21P PHONE 42 V- <br />h LZ� fiZ- NUM f•'� c (c :_' u06 I Al r>, S r s w L-�/L)z 1, ;; �leZzd zyu &br <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br /><,A>rtic <br />h1A)'ILv l_((/kS 42Ili` Zgr)at,6u <br />CONTRACTOR �,Cb -AL t-ilVA/t,(3 Lim ADDRESS CITY2IP PHONE <br />CONTR. LICENSES 7 Il�ltx SitS&V (Z'L7a zf LI1t'zau 7GCt, <br />f`ll rn orb <br />g�Sor� z4., <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />s�-K <br />I <br />— Electric Gas Other <br />L ,,G,p � <br />—I <br />WORK DESCRIPTION <br />NFvJ s� <br />PLUMBING <br />MECHANICAL <br />N0. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet .' <br />A/C - airhendling units <br />Bathtub ,. � <br />Lavatory (,Vjsh basin) <br />Forced air systems <br />Gas piping <br />Shower! <br />Water heater <br />Kitchen sink 8 disposal <br />•� <br />Gas fireplace <br />Dishwasher <br />+ <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood <br />Sink (servicelbar/mopletc) <br />Exhaust fan r+/ <br />Back9ow preventer <br />Heat pump <br />Udnal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />L <br />other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />I hereby cemiW that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces g%veming this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give a Inority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />censt on. That I am au rued b e owner of This property to perform the work for which application is made and I comply with the <br />State Fnitr pore law 18 �RCW 298.200 WAC. <br />111'� v <br />Signature o erl onlrectod ut Onz gent e <br />