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( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3�C0 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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> � <br /> � SITE ADDRESS C-' �1�h t ^ �� � � PARCEL TAX I.D.:i PERMIT i1 <br /> /ODO �/ T" . 2 905/$DOZ06/DO �)�� � <br /> LEGAI LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> />ol1T OF El/ERETT 29//�OrVO ST. Et/E,QETT 98206 4ZS-38B-0603 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> j POL/ L U/S 4Z5-38B -0603 <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> � CONTR.LICENSE p <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> II _Etectric _Gas_Other <br /> WORK DESCRIPTION <br /> DEit�o��Sh�EX�ST/NG BU/LO/N6 NO. 2/ <br /> (PvRr���'�NF2 y�cyTs�OcEs) <br /> � PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toi�et AIC—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> I = Dishwasher = Gasrange <br /> Clolhes washer Clothes dryer <br /> _ Laundry Iray _ Range hood <br /> SirR(service/badmoplelc.) � � Exhaust fan <br /> �ackflow preventer ;'�� `� _ Heat pump <br /> Urinal ��" _ Unil heater <br /> � _ Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Greaso trap Woodslove <br /> Roof drains Olher <br /> O�her <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 7105 <br /> I hereby cerilifq Ihat I hr .e read and examined lhis appiication and know lhe same to be Irue and wrrecl All provisions of laws and <br /> xdinaces go���ming Ihis type of work will be compiied with whelher specified herein or not.The granting of a permit does not presume <br /> to give authorily to violate or cancel the provision of any other slale or local law regulating construclion or the performance of <br /> conslruclion.Thal I am t '{e by the owner of this proparty lo pertorm the work for which application is made and I comply with the <br /> Stale Contractors La 8. � RC and 296.200 WAC. <br /> ` J h. �� �5 <br /> :iignature o wned o r GoNA horized Agent Date <br />