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Pt :RMIT APPLICATIC J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAf� S';�REET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM e AM TO 4 PM <br />SITE ADDRESS n� I� Qip I�M� �(� � Q, <br />L is�, � nyi � v,�i „�_ <br />LOTNO.i�ij I BLOCK <br />DESC. <br />TENANTNAME <br />IpARCEL TAX I.D. p — <br />TRACT <br />�1DDRE85 CITY2IF <br />Q9'f� �i(/E 1/0�- � <br />CONTACT FOR PERMIT <br />�l'� �2� �/ h eJ <br />?/R�M/IT # - � <br />l� / �% � ���' , <br />PHONE <br />DDRESS CITYIZIP �PH�^ON ' 7O <br />CONTRACTOR �� /Jm��, ��o -�� � � <br /><J�-C gs�y' ��',,c �C/�/oz, ��'�tic� �iA- <br />cot+rn. uceN e r <br />��D�L� HEAT SOURCE CONTRACT PRICE OF WORK <br />USE OF BUILDING I I <br />Eledric ✓�es,_Ofher <br />WORK D SCF R�PT�ON � O� <br />�L.. �.'— � <br />c(rj%CJ(X� <br />ND. I TYPE OF FU(TURE OR ITEM <br />Toilel <br />Bethlub <br />Levatory (wash besln) <br />Shower <br />Kilchen sink 8 disposel <br />Dlshwasher <br />clocnes wesfier <br />Leundry tray <br />Sink (servicelberlmoplelc.) <br />Beckflow preventer <br />Urinel <br />Drinking Founlein <br />IFloor drein <br />Groese trep <br />Roof dreins <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />PJC - elr hendling unHs <br />L Forced alr syslems <br />= i Gas piping <br />y, Walor heater <br />1 Ges fireplece <br />L Ges range <br />1 Clothes dryer <br />_� Range hoocl <br />. Exheustlen <br />Heetpump <br />UNt heeter <br />�' Boilei <br />� RetdBeretlon <br />Woodstove <br />Other___� <br />CI7Y OF EVERETT LOCAL 9ALES TAX CO�E IS ]106 <br />I hereby ceritify thet I have reed and exemined Ihis epplicellon end know lhe seme to be true end correcl. All p%rc a�8 �ot pres me <br />ordinecas goveming this typa of work will be complied wfth whelher apadfied hereln or not. The grenting of e pe �o�B^� o� �� the <br />to give eulhority to vlalete or cancel the provlslon o1 eny other stete or locel lew reguleUnB �nstructlon or the pe <br />construction. Thet I em euthnrized by the awner of this propeAy to parlorm the work for whlrh epplicelion Is mede end � comP�Y <br />Stete ConUectors Lew 18.27 RCW end 288.200 WAC. � <br />;� <br />