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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERE'f T, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereftwa.org <br />APPLICATIONS ARE ACCEPTED "ROM 8 AM TO 4 PM <br />SITE ADDRESS <br />9,5o9, 19411 Ave sE 4C a81v <br />PARCEL TAX I.D. # <br />00.51SDO <br />PERMIT # <br />LEGAL LOT NO. BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />WFl J067.501-, FA IV). poal,er5 84 Ave Sr. rwAe7-Y, I -A -VOz7- 59io <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />L-ESLIE Ko(;riL <br />I Job,l-IA-P,yll <br />CONTRACTOR84I ^ �e2Vr1 Ltf ADDRESS CITYIZIP PHONE <br />J 1621Z 3J1',+LLL.LVEei`fT p11LLCr:rf_k' CIZS <br />CONTR. LICENSE# iJWY 41 i'sz39 <br />BBT J1 r '. Pq L of 330- d/�p <br />USE OF BUILDING <br />HEAT SOURCE <br />CONT CT PRICE OF WORK <br />1•U2AIJGF AGF�eY <br />Gas Other <br />U <br />_Elec:ric <br />)�s(� <br />WORKDESCRIPTION jN$TFlL(r nLASTrr 'D1r1E1J510NA& LETrr.fZS 'rO Tr+E A,$G10q <br />ON TNF_ S16,c O�--- '8011-DhQG,. /NS}ALL /(LUM/A1�15F_D CA&IvET <br />:51r To NORl'NF_FlSi S/DE OF 13V/LJ/NG - <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />NC — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_� <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Laundry tray <br />_ <br />Range hood <br />_ <br />Sink (servicelbarlmoplelc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />heal 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 />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify 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 1 comply with the <br />State Con aclo aw 18.227 RCW and 296.200 WAC. <br />�ZJ�lO� <br />Signalur Vwner/Contractor/Authorized Agent Date <br />/ <br />1 / 7i <br />