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F� :RMIT APPLICATI:,N �,� � <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �`b <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT# <br /> IoDo s� �v�rcfl�Ma!l WAV Sf� 305 lYzS 053 as-g � oz ,� 'l/ � :- .-, <br /> IEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �FLU���� �JE�ZETT }�0�-DINC�S,LI,G �o� �NIDN ST�`5 S� ,uut — <br /> TENANTNAME CONTACTFORPERMIT y;���������L ONE <br /> �XIC�E�E �I� �OI.U��ZS �E2�K E �� �5315/35� `12- -'�r-�-3133 <br /> CONTRACTOR �g� ADDRE55 � PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��IC� ��) _Electric _Gas_Olher ��� � QQU <br /> WORKDESCRIPTION T��y�j— �y�ppV�Mel�'� ���LtVi Cx�s11VIc' oi-F�c sp%ce -(�yY ��� ,aS 0. M��� <br /> ���•�� , �lucx{-chbr v.ln✓I� is iv,c�urJ-ed. Iv�+cvivr vcnuva-tio�s �tt� ihclude dcv�v��t�vt� of ah <br /> exis{• o4.mis(nq �Jxll �, �vuvr.lehe�a �I.ew�isiv� ��ull-fo1� lano�.e,r-�c�o+vii- Sp�C• Ivl•Fill cni�-. enl-vy <br /> aooYs rc�ii-C.�pv(c�L nc� f�✓t�tian w0.�ls = rcloc�tc��� �x�s+-iv�d�'�RoKd-� v�.ew casec�,rorK. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE UR ITEM <br /> Toilet A/C—air handling unils <br /> BathWb Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> laundry tray Range hood <br /> � Sink(service/har/mop/etc.) Exhaust fan <br /> Backilow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Flour drain Re�rigeration <br /> Grease lrap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SP.LES 7AX CODE IS 3705 <br /> I hereby ceriti(y that I have read and examined lhis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whelher specified herein or noL The granting of a permit does not presume <br /> lo give aulhoriry to violale or cance�the provision of any other state or local law regulaling construction or the performance of <br /> construclion.That I am authorized by the owner of this property to perform the work for which application is made and�comply with lhe <br /> State�ractors Law 1 . 7 RCW and 296200 WAC. <br /> h/�r�. �"�s"��' ��2, <br /> Signature o wnedContractor/Authorized Agent Date <br />