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�'�-r. 22. 2013 i2: 16P�1 ko. 94g�� P. 4 <br /> i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S7REET, EVERETT,WA 98201 <br /> 425•257-8810—FAX 425-257•8857—www.everetlwa.orp <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRCSS PARCEL TAX I.D.# PERMI7# <br /> a � M�`ziUS — D3q <br /> LEGAL LOT N0. BLOCK TRACT OR SUBOIVISION q <br /> CESC. <br /> OW17ER AUDRESS CITYRIP PHONE <br /> �� 1�o► h�P.�/' �Ct�+��. �015 0`�5 <br /> 7ENANTNMtE � CONTACTFORPERMI7 PHONE(,�� Z���E'.� <br /> I ? ie �.h,���lebbie@cmf�c��i�q. �n� <br /> cmH2a�irtcjr�lc, �I+iSBr uaa.� �ea�ek4 987-�c�n��}25Z��6k� <br /> CONTR��C[�NSE .y� �qSR� <br /> �C�� 7f <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICC OF WORK <br /> ,�[Icclrlc _Gas_Other (��,7� .� <br /> WORK OGSCRIPTIO� �� ^ �� <br /> � �� t��- '� <br /> pLUMBING MECHANICAL <br /> NO. TYPE OF FIXYUqE OR ITE67 NO. TYPE OF FIX7URE Oli IiER7 <br /> Toilet ,_ PJC—airhandlingunits <br /> BatMub Forced air sysloms <br /> � Lavatory(wash pasin) � Gas piping <br /> � Shower . Water heater <br /> Kilehen sink&^I�sposal _ Gas Ilreplace <br /> �� Dishwashes Gas ranga <br /> Clothes washer T Clolhes dryur <br /> Waler heater Range hood <br /> _ Sink(sarvice/bar/mop/otc.) � Ezhausl tan <br /> Rackllowprevenl0r _J._, Hoatpump <br /> Urinal Unit hcater <br /> Drinkinfl�ountain .___ Boiler <br /> � Floordrain Refrigeratiott <br /> Gredso Irap Woodstove <br /> � Roof drains _� O�het <br /> Other ' <br /> CITY OF EVEFETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriUly Ihnt I have read and oxaminatl lhis appiicalion and knoe�the same to be Irue and correcL All provlsions ot laws and <br /> ordinacos govorninfl Ihis Iypo ot work wlll�e complled wllh whelhor spacif�od herein or ro4 The granling ot a parmil dces not presume <br /> to give authorily to violate or cAncel Iho provlclon of�ny other slflte or Iaca1 I2w rogulatinp concW cllon or the pedorm:tnce of <br /> conslruction.Thal I am aulhorized by tho owner o(thts property to padorm ihe woB for which nppliCalion is matla and I comply with ihe <br /> Stato Conlractors Law t 8.27 RCW and 236.200 wAC, <br /> � 'e, ' o�,c 5,a�.1'� <br /> Signatu •ot Owncr/Co aclodAulh ii Aflent Oate <br />