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P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 88201,425-257-8810 <br /> sITE ADDRESB PARCEL TAX 1.0.• P�+MIT M <br /> �crsor� IVd 50 - 000- 0�9 - 0005 C.c� -oao <br /> LE4AL LOT NO. . lIOCK TqACT <br /> UESC. YrIQ � � � � � <br /> OWNER ADORlSS pHpNE <br /> �1;k� c Br�d�et Lc.rse,•�+ 3 �o 141�e�sor+ $Ivd w,s- as9- ���3 <br /> TENANT NAME CONTACT NAME ��E <br /> YI'l�kr f l�r���i Lanc., ►1'1�ke �Larsw► Nzs - aS9- 7r�3 <br /> CONTRACTOR �Q�� �,�5+. ADDpEbs CONTR.LICENiE� <br /> PHONE yas-asti- �i� 3ia �41,�ersw� 8l�d uq�scc * io�erF <br /> PROPOSEOUS80FlUILDINO Buildinp M�ch�nbal Adanbn HEATWURCE <br /> PERMR Combinetlon B Plumbinp W011K An�nnon DENcalc <br /> /�� TYPE D�molitlon D S�pn ri/! � PNw �] f�. <br /> l�.(1�C BPhnkl�r pp�idM�Mt U OiMr <br /> CONTRACT PRICE Of WOqK 0� 00 CITy pf ryt�[TT�p�AL�s TA7I C00[M�106 <br /> WORK D[bCRIPTION u�� !k f� <br /> ri <br /> P�uMsiNo <br /> N0. TYrE OF Fl%TUIIE 011 rt[M N0. TYM 0I AXTIM[OII RtM <br /> _ WATERCLOSET _ A/C-MIANOLINOUNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ UVATORV(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 6 DISP03AL _ CLOTHEB DRVER <br /> _ DISHWASHER _ RAN�E HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> _ CIOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPUCE IN8ERT <br /> _ DRINKINO FOUNTAIN _ QAS FIREPUCE <br /> _ FLOOR DRAIN _ OAS RANQE <br /> _ BACKFLOW PREVEN tER _ (iA3 PIPINO <br /> _ SINK(SERVICE/BAHrMOP/�TC.) _ FJ(HAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBV CERITIFV THAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND COqFECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES 60VERNINO THIS iVPE OF WOFK WIIL BE COMPLIEO WITH WHETMER SPECIFIED HEREIN OF <br /> NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO 61VE AUTMORITY TO VIpLATE OR CANCEL THE PqOVISION OF ANY OTHER <br /> STATE OR LOCAL UW REdUUTINO CONSTRUCTION OR TME PERFORMANCE OF CONSTRUCTION. TMAT 1 AM AUTMOi112ED BY TME <br /> OWNER OF THIS PROPERTY TO PERFOFM THE WOHK FOR NMICH APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br /> CON7RACTONS LAW iB.27 RCW AND 298200 WAC. <br /> �1'��O�J/S� a- �/-O� y� <br /> Slgnalure ol OwneUContreqodAu z pent D�t� <br /> /(p3. 3/ <br />