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PE� _NIIT APPLICATIOti <br /> CITY OF EVERETT PEf2MIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857—www.everettwa.org z ���`�� <br /> J <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDoF�� PARCEL TAX I.D.# I PE MIT# <br /> `l�l/ 'i 'r� ' v � Z905i'80020 ' <br /> /�`��l 7 '� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> I OWNER ADDRESS CITYIZIP PHONE <br /> /�oRT OF E!/E�PETT 29//�Ort/D ST. El/E�PETT 98206 4ZS-3f3B-06o3 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> I PoL/ L U/S 4Z5 3B8 -060.3 <br /> CONTRACTOR qDDRESS CITYIZIP PHONE <br /> CONTR.LICENSE# <br /> I USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric Gas Clher <br /> WORK DESCRIPTION <br /> DEMOL iSH E Xis7'/NG �U/L O/N6 ,� �,f' ; / <br /> � � 11 <br /> �, 'J <br /> �,_/���,'�_1 ��;1(r_"i�' ��� ���l.l, <br /> �- ., - <br /> PLUMRING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYpE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling units <br /> _ Balhlub Forced air syslems <br /> _ Lavalory(wash basin) Gas piping <br /> Shower NJaler healer <br /> _ Kilchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clolhes washer Clolhes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/moplel;.) Exhaust fan <br /> BackOow preventer Heat pump <br /> Urin3! Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Rofrigeration <br /> Grease lrap V��oodslove <br /> Roof drains Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> i hereby ceritify thal I have read and examined Ihis application and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces guverning this type of work will be complied with whether specified herein or not.The granting of a permit does nol presume <br /> to give authority to violale or cancel the provision of any olher slale or local law regulatinc�construclion or the pertormance of <br /> conslruclion. That I m rized by Ihe owner oF this property to perform the work for which application is made and I comply with the <br /> Stale Conlracl rs .27 W and 296.200 WAC. <br /> � .i6•c� <br /> Signalure of Own or/ ulhorized Agent Date <br />