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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />320J CEDAR STREET, EVERET-1, WA 98201 <br />425 257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO PM Q <br />SITE ADDRESS <br />c13 LA- PL S<li <br />PARCEL TAX I.D. R <br />I (, '1i.)�>C`C�IC> <br />PFRMIII' •Q /� <br />U)�Iii U' (�[r� <br />LEOA LOT N0. <br />DESC. <br />BLOCK <br />TRACT OR SUBDIVISION 0 <br />,. i'\{r}{! �.-C��t'� (�<,.<r<trr� f,(Lv+ ccrckl) <br />�1 <br />{r <br />OWNER ADDRESS CITyrzir PHONE <br />/1 <br />l q -AJeV, �retitt L- ! ?)12 V 6'Ondkku I �:V,V 2y C ✓e/elf gbaWj, LjIS 217 Zito <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE ,•f 2S 1 S'L k 1 -21 IQ x 2/.2 <br />I Vrip,t:b''r✓ E-MAIL,,'ulSk'01t Cz'rYielu w. <br />—CONTRACTORr, ry..\ 4.... Pr. l (..gyp r..•—hB IC IiP IXnISk (nK,. Sf nFl <br />CONTR. LICENSE I ��p b�;� r-Q- ci�,t,•FJ; <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />%lOt.i I$Tr- <br />Electric Gas Other <br />WORK DESCRIPTION <br />-7 ci IZt(z <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTI IRE OR ITEM <br />'T,� <br />Toilet <br />A/C - air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />= <br />Gas piping <br />Water heater <br />Shower <br />Kitchen sink 8 disposal <br />Gas fireplace <br />r <br />Dishwasher <br />Clothes washer <br />Gas range <br />Clothes dryer <br />Water heater <br />i_ <br />Range hood <br />Sink (servicelbar/mop/etc.) <br />'i-- <br />Exhaust fan <br />Baclgow preventer <br />_Heal <br />pump <br />Urinal <br />Unit haater <br />_ <br />Drinking Fountain <br />Boller <br />Fkvr drain <br />Refrigeration <br />Or4�9se trap <br />Woodslove <br />_ <br />_ <br />Roof drains <br />_ <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE 19 3105 <br />1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be compiled with whether specified herefn 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 />constnwtfon. That 1 am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />\StSte Onlractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner ontracfor7 u�nzAgent Late <br />V3 <br />