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PE�MIT 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 /> 3 �%3-�,C <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS TN PARCEL TAX I.D.# PERMIT# <br /> 4// /3 ST 2905/f�00Z049�D ;>/�'��` � <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> /�o2T oF E�ERE TT 29//�D/�/D ST. EI�E,PETT 98206 4ZS-38B-06 03 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> PoL/ L[//S 4Z5-38B - 0603 <br /> CONTRAC70R ADDRE55 CITYIZIP PHONE <br /> CO�ITR.LICENSE# <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Olher <br /> 4'lORK DESCRIPTION <br /> �EMOL/Sh'EX/ST/NG BU/LD/N6 NO. /Z,4 � /Z� <br /> �,E1��2/cAti' CONSrTlC/cT�O�/J <br /> PLUNIBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilcl A/C–air handling unils <br /> Bathlub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler h2aler � <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> _ Laundry lra;� Range hood <br /> __ � r,�c(service/badmop/elc.) �i / Exhausl(an <br /> b,�ckflow preventr �'�. _ Heal pump <br /> __ Urinal ����' _ Unitheater <br /> _ Drinking Fo�nlain � Boiler <br /> Floor drain Refrigeration <br /> Grease Irap Woodslove <br /> Root drains Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TOX CODE IS 3105 <br /> hereby ceritify i��al I have read and examined Ihis application and know the same l0 6e true and correct All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whelher specified herein or noL The granting o(a permit does not presume <br /> t.�give authority lo vfol�te or cancel the provision of any olher slate or local law regulating construction or the performance of <br /> conslruclion. Thal I m ��if d(iz¢d by thc owner of lhis property to perform the work for which applicalion is made and 1 comply with the <br /> Stale Conlrac{ors L' v 1,8.27 Rd/J and 296.200 WAC. <br /> �����. I. -. !� ��� c`S. ���.�'S <br /> Signature of Ownorl l�Got/ Nthorized Agenl Date <br /> _. 4 "' � <br /> � <br />