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Sep. 6. 2012 9 : 58AM No. 5105 P. 5 <br /> • • <br /> PERMIT APPLICATION <br /> ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-25T8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � ( ��� 6IQ <br /> PARCEL TAX I.D.# I PERMITfit, �^ O � 2— <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESG. <br /> OWNER <br /> ADDRESS CITY/ZIP PHONE L 0 <br /> TENANT NAME CONTACT FOR PERMIT PHONE LZj 2 j <br /> 1 _�l�ie E.MA►iclebbie@cmht h acme <br /> .P0" • •/ IP' PHONE- <br /> col <br /> HONEcol Ho. IA 16c- 0-4-6 Br•. . -a\i exreit q$20 1ZS Zji�(061c <br /> cONTH` naT*. oci5R4 . <br /> USE OF BUILDING K HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric 1/ as Other 3 LA a 4^ ' <br /> WORK DESCRIPTION 1 trt may, v.'`L..)r\ (la J I:;yi, v.,,,,c. ...1.c.) <br /> 1 /5 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet NC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) j Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal I Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking FountainBoiler <br /> Floor drain Refrigeration <br /> Grease trapWoodstove <br /> Roof drains Other <br /> Other_ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 290.200 WAC. <br /> i 4i--. /4. I g-2C1- 12. <br /> Signatu.s of •wner/Co► actor/Auth iz: Agent bate <br />