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( <br /> � PEkMIT APPLICATION <br /> � <br /> i CITY OF EVERETT PERMIT SERVICES <br /> 3200 rEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPI ED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> /DoZ /3�ST 29oS/�3oozoS2o0 '� )"' -;j <br /> LEGAI LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> /�oRT OF E!/EiPETT 29//�OrVO ST. El/E�PETT 98206 4ZS-38B-0603 <br /> TENANT NAME CONTACT FQR PERMIT PHONE <br /> POL/ L[//S 425-388 -0603 <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE p <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> � WORK DESCRIPTION <br /> r�EMo�isNEXiST/NG BU/Lo/N6 No. ZZ <br /> I <�/�PEF'G,yT�2S /�''IUS�?C/rYI> <br /> i <br /> PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF PIl(TURE OR ITEM <br /> Toiiet A/C—air handling unils <br /> Bathlub Forced air systems <br /> _ Lavalory(wash basin) � 1 _ Gas piping <br /> _ Shower �N Water heater <br /> _ Kitchen sink 8 disposal ��� _ Gas fireplace <br /> Dishwasher �U Gas range <br /> Clothes washer � Clothes dryer <br /> _ Laundry tray � _ Range hood <br /> Sink(service/bar/mop/elcJ Exhaust fan <br /> Backllow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiier <br /> Floor drain Refrigeralion <br /> Grease lrap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined Ihis application and know the sama to be We and correcL All provisions of laws and <br /> ordinaces goveming lhis typo of work will be co�nplied with whether specified herein or not.The granting of a permil does not presume <br /> to give authority to viol or cancel the provision of an�other slate or local law regulating construclion or lhe peAormar,ce of <br /> :onstruction.Thal I a u o ' ed y the owner of this F�roperty to periorm the work for which application is made .,id I comply with Ihe <br /> Stale Contractors La 8 7 R� and 296.200 WAC <br /> '� > �.{b,tJS <br /> Signature of Owned 1 oA orized Agent Date <br />