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t <br />PUT <br />PERMIT APPLICATION OR z 202 <br />CITY OF EVERETT PERMIT SERVICE <br />3200 CEDAR STREET, EVERETT, WA98201 PUBLIC WORKS <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM tf --17 --1 Z <br />SITE ADDRESS PARCEL TAX I.D. R PERMR R <br />LEGA LOT NO. OCK TRACT OR SUBDIVISION R <br />DESC. <br />OWNER ADDRESS CRy21P PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT P►ONE ,'�D%'-/ 3- <br />'`H1 1\ E-MAILG I <br />,✓CIL�C'� lG i . L t�! <br />COATAx 5�7 <br />CONTR. LICENSER (^L tfi 31 31 <br />USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE 6F WORK <br />Electric _ Gas _ Other <br />WORK DESCRIPTION r <br />��-►'��xl����/� �/l��/�- OF ��1''. _ <br />PLUMBING MECHANICAL <br />NO.. TYPE OF FIXTURE OR ITEM NO. T/PE OF FIXTURE OR REM <br />_Xe <br />t A/C - airhandlingunits <br />_ ub Forced air systems <br />_ t (wash basin) Gas piping <br />_ er Water heater <br />_ en sin disposal Gas fireplace <br />_ washer Gas range <br />_ es washer Clothes dryer <br />_ r heater �_ Range hood <br />_ (service/bar/mop c.) Exhaust fan <br />_ flow preventer — Heal pump <br />al _ Unit heater <br />kingFountain _ Boiler <br />r drain — Refrigeration <br />se tra Woodstove <br />f dr ' s Other <br />— <br />CITY OF EVER LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify 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 1 cc reply with the <br />State Contractors w 18.27 RCW and 296.200 WAC. <br />Da <br />Signature of der/Contractor/Authonzed Agent r/y <br />