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�- PEFtMIT APP �LICATION <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-f� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# pERMIT# <br /> 6/5 /3T�ST z9d5/BOOZo7200 J?(_-�"��-� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �o/�T OF E!/EiPETT 29//80rV0 ST. E!/E�PETT 98206 4Z5-38B-06o3 <br /> TENANT NAME CONTACT FOk PERMIT PHONE <br /> PoL/ L U/S 425-388 - 0603 <br /> CONTRACTOR ADDRESS CITY2IP pHONE <br /> CONTR.LICENSE it <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas Other <br /> ' WORK DESCRIPTION <br /> DF,�o��s.s�E XiST/NG �U/L D/NG No. //, 4 d ¢/ �T1zuC� sc,AL E) <br /> (PUGET SoUNO J�2UcK G/NE-s�) <br /> PLUMBING MECHANiCAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEkI <br /> _ Toilet A/C-air handling units <br /> _ Bathlub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Sho�ver Waler healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher �� _ Gas range I <br /> __ Clolhes washer ,,;t Clothes dryer , <br /> Laundry tray �1'N� _ Range hood <br /> � Sink(ser:ice/bar/mop/etc.) .� Exhausl�an � <br /> _ BackOo:v prevenler �, Heat pump <br /> � _ Urina� ��� � _ Unil healer <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> , Olher <br />� — — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby cerit. y ihal I have read and examined this application and know the same lo be We and correct. All provisions of laws and <br /> ordinaces govem�ng�his rype of work will be complied wilh whether specified herein or nol. The granting of a permit does nol presume <br /> � to give aulhoriry to violate er cancel lhe provision of any other s�ale or local law regulaling conslrudion or the performance of <br /> construction. That I am �ul r 2e by�he ewner of this property lo per(orm Ihe work for which applicalion is made and I comply wilh the <br /> State Contractors�Law .2 C and 296.200 WAC. <br /> . <br /> �-� .i — <br /> � IL �v5 <br /> �ignaWre of U.vner/ onl �tod u orized Agent Uate <br />