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P�RMIT APPLICATI(SN � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, �',ieRETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—ww�ni.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRUM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SI E ADDRESS PARCEL TAX I.D.# PERMIT A <br /> ���� � Od�iSE Q 106 (�C� S��-170a�c�/ !�o/ __�o ��� -Dl <br /> !.EGA LOTNO. BLOCK TRACT � <br /> DESC. <br /> OWNER AD�RESS CITY2IP PHONE <br /> bU.l��Dcrt ��t' Po Paax (o� sr�towU56i w� �Zq� 425 33f 5o(�S <br /> TENANTNAME CONTACTFOR PERMIT PHONE <br /> NWr•5� l��(. . I ��V �cp�f,�fCi�Zi5 4�r 3n�(7 <br /> CONTRACTOR ��'� ADDRESS CITY2IP PHONE <br /> CONTfi.LICENSE# �(J�'�/�fG���� - <br /> USE OF BUILDING I — HEAT SOURCE • CONTRACT PRICE OF WORK <br /> Electric Gas Other ���� C�0 �� <br /> WORK DESCRIPTION <br /> T � _-- ---- <br /> PLUMBING MECHANICAL <br /> � <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced afr systers <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&dispesal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothns dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mopletc.) Exhaust fan <br /> Backflow preventer Heatpump <br /> Urinal Unit heater <br /> _ Drinking ountain Boiler <br /> Floor ain Refrigeretion <br /> � Gr�e trap Woodstove <br /> Roof drains Other <br /> Otfter <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I <br /> j I hereby ceritify that I have read and examined this applicatlon and know the same to betrue and cortect. All provisions of laws and <br /> , ordinaces governing this type of work will be complied vith whether specified herein or noL The grantlng of a permit does not presume <br /> ro give authonry to violat r cancel the provisron of any other state or local law regulaung construction or the perfortnance of <br /> I construction.T ut ized by the ownerof this property te perform the work forwhich application is mede and 1 comply with the <br /> Slate Contra d 296.200 WAC. <br /> , l�• �,a <br /> ! Signature of wn or/Authonzed Agent Date �f� <br />