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�_ <br /> PEkMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-2E,7-8857—www.everettwa.org 3 `�; -0� <br /> APPLICAiIONS ARE ACCEPTED FROM S AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P MI7# � <br /> B/¢ /3 �sT. 2905/800206800 � ; <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> /�oRT OF E!/ERETT 29//BO/�ID ST. El%E,PETT 9B2U6 47.S-38B-06o3 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> Po�/ L i1/S 4Z5-38B - 0603 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE C <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> , WORK DESCRIPTION <br /> OEN9oC/Sh'E X/ST�N6 BU/LO/N6 NO• 8 <br /> (/>OPEyES� <br /> I PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling unils <br /> Bathlub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Weter heater <br /> Kiichen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/elc.) Exhausl(an <br /> Backflow preventer � ��' Heal pump <br /> Urinal \ l�' Unil heater <br /> Drinkin� Fountain — _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> , Other — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify�hal I have read and examined this application and know�he same to be true and correct. All provisions of laws and <br /> ordinaces governing ihis lype of work will be complied with whelher specified herain or not. The granting of a perr-iit does not presume <br /> to give aulhority to vioYat or �ancel the pro�i;ion of any olher stale or local la•,v regulaling conslruction or the performance o( <br /> ronsiruction.Thal I m a t��r ed'by the owner of this property to perform Ihe work for which application is made and I comply with lhe <br /> S�ale Con�rac rs L� �27 R� and 296.200 WAC. <br /> . ��%�' r� �L O y <br /> � Signature of Owne o � r/Au horized Agent Dale <br /> - -- c------ <br /> – ------ --- <br />