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i � <br /> PEkMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> � �'�� ' <br /> � �- ��PPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE.ADDRESS PARCEL TAX I.D.# PERMIT�t <br /> �. °"�`� /3�,.5'T 29b5/BOoZO¢BOO n' � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> /�Dl�T OF El�E�t'ETT 29//�D/JD ST. El/E�ETT 98206 4Z5-38B-0603 <br /> TENANT NAME CONTP:T POR PERMIT PHONE <br /> Po[/ G U/S 4Z5-38B -0603 <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Olher <br /> �VORK DESCRIPTION <br /> DEMOL/S•S�EX/.ST�N68U/LO/N6 NO. Z3A �1L�' <br /> �„�� s,eoo,es �.�,4�J - _ _._ �C� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FU(TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) Gas pipin, <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> _ Dishwashcr Gas range <br /> Clothes washer Cblhes dryer <br /> Laundry tray Range hood <br /> Sink (service/bar/mop/etc.) Exhaust fan <br /> Backfiow preventer Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> . Grease trap Woodstove <br /> Roof drains Other <br /> O�her <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 7105 <br /> I hereby ceritify thal 1 have read and examined this application and know the same to be Irue and correct. All provisions of laws and <br /> ordinaces goveminc�this lype of work will be complied wilh whether specified herein or not.The granting of a permil does nol presume <br /> a give aulhority to violale or cancel the provision af any other slate or local I�w regulaling construction or the peAormance of <br /> .:onslruction.That I � t �(ized by lhe owner of lhis praperty to perform Ihe work for which application is made and I compiy with the <br /> 3late Contraclors La 1 7 A2 W and 296.200 WAC. <br /> I <br /> ��� (✓, VS <br /> Signaturo o O:ener cxtor/ ulhonzed Agont Date <br /> � <br />