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Nov. 29. 2012 909A No. 6159 P. 2 <br /> i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> 00 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT#b _ O� <br /> [� �� <br /> LEGAL LOT NO, BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWN R ADDRESS CITYOP PHON <br /> R'dyv- McFarlaoA 425- 970 s <br /> TENANT NAME CONTACT FOR PERMIT PHONE4Zb 2cE;r-I 4"k2 <br /> 1-'D2bble <br /> E-MAItijabbi C &Mel <br /> 6DDRESS CITY/ZIP <br /> CM t4'e nq <br /> CONTR('�LICE SE <br /> v * o R4 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric ZGas_Other 5D <br /> WORK DESCRIPTION <br /> 2ef[az5as a <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO, TYPE OF FIXTURE OR ITEM <br /> Tollet A/C—air handiing units <br /> Bathtub Forced air systems q'(A-% - j r <br /> Lavatory(wash basin) Gas plping <br /> Shower Water heater <br /> Kitchen sink& disposal Cas 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 Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3103 <br /> I hereby ceritlfy that I have read and examined tills application and know the same to be true and correct. All provisions of laws and <br /> ordinates governing this type of work wlll 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 focal 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 f comply with the <br /> State Contractors Law 18,27 RCW and 296.200 WAC. <br /> Signatu of Owner/Co actOr/ uth Agent Date <br />