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PL.ZMIT APPLICATIGA <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — mvw.everettwa.org <br />APPLICATIONS ARE <br />ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />/oa-�I515w. <br />C)�o3 GZU <br />LEGALL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER <br />ADDRESS C TY21P PHONE <br />T <br />P�se_�l / 1 T oMr.S S, <br />c � <br />/002 O I5�5} StA) I.JCYLV' WC" (4ii) 340 (35 85 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />jr'-r r+S Owr�S— <br />T�hn S�l�'�(-1 (1/,3S) �JI"33T q 1 <br />CONTRACTOR au�lL� <br />ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric A_ Gas <br />I 3SoC) <br />—Other <br />WORK DESCRIPTION <br />U( % K. �cl.cn tjc {C,f: •f' 61)(M WAA Gu'� a31_K I� toe'\ CCA"R Fire CFiy�:�l <br />(001"'PDL111j OA �3irvLC_ ltiY�.1� i <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C —air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water healer <br />Kitchen sink 8 disposal <br />Gas fireplace <br />X <br />Dishwasher <br />Y <br />Gas range <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Laundry tray <br />_ <br />Range hood <br />_ <br />Sink (service/badmopPdc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Olhe, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby eeritity that I have read <br />and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates goveming this type of <br />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 state or local law regulating construction or the performance of <br />construction. That I. m authorized by the ow r of this property to perform the work for which application is made and I comply with the <br />State ConI actors La� 18.27 RC and 96.20 AC. <br />// <br />�� U3c.3c)s <br />S/�) <br />S gnature of Oymer/Contract6r/Authon'zedgent <br />Date <br />I/� <br />