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PERMIT APPLIC�►TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CE�AR STREET, EVERETT, WA 98201 <br /> 425-257-881 J - FAX 425-257-8857 -ww�,v.everettwa.org 3—�,3 �� <br /> i <br /> APPLICATIONS ARE ACCEP7ED FROM F3 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# pERMIT# <br /> ¢�o i4 � sr. Z r''/05/BGOZ05�00 ) �;(�;' -�v <br /> IEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIF' PHONE <br /> /�DRT OF E!/E�PE TT 29//�30%10 ST. E!/E,PETT 98206 425=38B-O6 03 <br /> TENANT NAME CONTAC i FOR PERMIT PHONE <br /> PoL/ L U/S 4Z5-3BB -0603 <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE q <br /> USE OF BUILDING I — HEAT SUURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> 'NORK DESCRIPTION <br /> .�EMOL/Sh�Ea'iST/NG gU/GO/NG No. /¢ <br /> �M/GL TOWi✓S•A�L.> <br /> PLUMBING MECHANICAL <br /> I NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilot _ F_C—air handling units <br /> I Balhlub Forced air systems <br /> _ Lavalory(wash basin) � _ Gas piping <br /> Shower _ Water healer <br /> Kitct:en sink 8 disposal - �% Gas fireplace <br /> `=iwasher � �Y�',� _ Gas range <br /> _� Clolhes washer 1 _ Clolhes dryer <br />\ _ Laundry tray _ Range hood <br /> Sink (scrvice/bar/mop/elc.) _ Exhausl(an <br /> Backflo::preveNer _ Heat pump <br /> Urinal Unit healer <br /> Drinking FouNa':. Boiler <br /> Floor drain _ Refrigeralion <br /> Grease lrap _ Woodstove <br /> � Roo(drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritc�thal� have read and examined Ihis aGFiicaiion and know the same to be lrue and correcl. All provisions of laws and <br /> rdinaces gove�ning lhis type oi worA will be complied with whether specified herein or not. The granling of a permil does not presume <br /> tu 9ive aulhorily to violate, cancel�he provision of any olher state or local law regulaling conslruclion or the performance of <br /> onslructior:. That I am lh ri�d y lhe owner of lhis property lo perform lhe work for which application is made and I comply with Ihe <br /> �tale Contrectors \ w 1 .27 CW nd 296.200 WAC. <br /> �\ �l- ! �> - ,o <br /> SignaWre of Owner/Conlr, tQr Aul brized Agent Date � <br />