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SITE ADDRESS <br />�,1� D ( <br />LEGAL LOT N0. <br />DESC. <br />( �G • <br />NAME <br />Pf�RIVIIT AP�LICATIGnI <br />CI'i Y OF EVEF2ETT P�RNlIT SERVICES <br />3�C0 CEDAR STREET, EVERETT, WA 98201 S, a-7_ OCa <br />425-257-8810 - FAX 425-257-8857 � <br />Pp �bS D/� <br />PARCEI_ TAX I.D. # � P�RMIT � <br />% �' Y[� CJ/S <br />BLOCK TRACT <br />CONTACT FOR PERMIT <br />PHONE <br />��c-sTe,� �,UG` vri �,��� I _ <br />CONTRACTOR ADDRFSS r� ZIP CONTR. LIC.ENSE # <br />�✓—c��;/l(SE�� �)�ECf-�RnrcCr.� ((Gn 3/ I?�1c'�A� � SU?A/US�+1l8'Zc'�4 <br />PHONE /�K�� J� UJ��- g�2 z3 <br />PROPOSE USt OF UII_DING � <br />}�LCCL C�iG1�L <br />Building Mechanical <br />PERMIT R Combination � Plumoing <br />TYPE g Der,tolition Sign <br />Sprinkler <br />Additioi HEATSOURCE <br />IWORK R Alteration I [� Electdc <br />nNe D New U Gas <br />U RepaidMaint. U Other <br />CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3'105 — <br />WORK OESGRlPTION ' <br />I��C.00C��' � Sl �!(� <br />NO. I TYPE OF FIXTURE OR ITEM <br />IVATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVtN7ER <br />SINK (SERVICE/8AR/MOP/ETC.) <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C —A/HANDLING UNITS <br />FORCED Ali� : �YSTEMS <br />HEATPUMP <br />UNIT HEP.TEFi3 <br />CLOTHES DRYER <br />RANGEH000 <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPL4CE INSEkT <br />GAS FIREFLACE <br />GAS RANGE <br />GAS FIPING <br />EYHAUSTFAN <br />OTHER <br />� I HEREBY CERITIFY THAT 1 HAVE READ AN� EXAMINED THIS APPLIG1fION AND KNOW TNE SAME TO BE TP.U� ,1ND CORRECT. ALL <br />I pFOVISIONS OF LAWS AND ORIDINACES GO'JERNING THIS TYPE OF WORIC WILL BE COMPLIED WITH WHETHER SP[CIFIED HEftEIN OR <br />ifJOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PFOVISION OF ANY GTHER <br />STFTE OR LOCAL f.AW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I qM AUTHORIZED BY THE <br />0`vVNER OF THIS PROPERTY TO PERFORM TVi� WORK FOR N'HICH APPLICATION IS A4ADE AN� I COMPLY WITH ThiE STATE <br />I CONTRF�CTORS LAW 18.�.j R:54' AND 296200 WAC. <br />D�BIT & CREDIT CARDS ARE NOT ACCEPTED <br />