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N �RMIT APPLICATI� N <br />CITY OF EVERETf PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />��.PPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADURESS ��� (L � �,,,,�MI I., 1„�n p <br />(�F'i�ll I��I � 1L l•1ti11V <br />LEGAL LOTNO. � I BLOCN TRACT <br />OESG � <br />TENANTHAME <br />CONTRACTOR <br />CONTR. LICEN$E N <br />USE OF BUILDING <br />PARCEL TAX I.D. N <br />�i(/E 1/oz <br />CONTACTFORPERMIT PHONE <br />��.Z7 �2La �/ h� �2S-75y - <br />�_ fw 't .ADDRESS CITYRIP PHON <br />p /u+� .�;,� y23- S� <br />���� 9si� 5�� �t/�/az, (��'�tiu� <br />WORK D SC` � RIPTION � <br />LC., �� <br />C�DGG� <br />TYPE OF FI%TURE OR ITEM <br />Toilel <br />Bethtub <br />Levatory (wash basin) <br />Shower <br />Kitchen sink 8 dispusal <br />Dishwesher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mopletc ) <br />Backflow prevenler <br />Urinal <br />Onnking Founlain <br />Floor drain <br />Grease trep <br />Rool dreins <br />Other <br />G✓�- <br />HEAT SOURCE I CONTRACT PRICE OF WURK <br />Electric ✓ Ges _ Other <br />�,�.��;l,�. � <br />NO. I TYPE OF FIXTURE OH ITEM <br />A/C — air handling unils <br />�Forced eir systems <br />Gas piping <br />y Waler hea�er <br />1 Gas hreplece <br />� Ges range <br />J_ Clolhes dryer <br />� Renge hood <br />;-!f Exhausllan <br />_ � Heelpump <br />Unit heater <br />'� Boiler <br />Refrigeration <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7706 <br />I hereby cerdlly Ihat I have read and exammed Ihis eppGcstion end know the same to be true and correct. All provisions ol levrs end <br />ordinaces goveming this type of work will be complied with whether apecified hereln or nol Tle grenting o1 a permit does not presume <br />to give euthonry to violate or cencel Ihe provision ol eny other stete or local law reguleting consWdion or tho performance ot <br />construclion. That I am authonzed by the owner of this property to perfortn the work for which epplication is mede end 1 wmply wilh the <br />Slate Contractors Law 18.27 RCW and 296200 WAC <br />i '� <br />SgneWr— e o`�wned ontractorlAuthonzed Agent e� <br />