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�ERMIT APPLICAT �JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� _��� <br /> SITE ADDRESS PARCEL 7AX I.D.# PERMIT# <br /> C'.' �->a�c.,.,� D�S�' S o S !I -� <br /> L[GAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ^ ADDR[SS CIN21P PHONE �yJ j� <br /> X 4.�/VV� ���i/�,_!Csf� •/- �C�� �PrJ,'ir //✓t L�lti'[YT �/�' -/(��V� O5�J�7 � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> �� � <br /> CONTR.LICENSE M <br /> O�.Jiv,e il " ,,,,.� ,.-s � /�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /�_ f= _[leclric _Gas_Othor <br /> i i / <br /> WORK DESCRIPTION <br /> ����i s t L' <br /> PLUMBING MECHANICAL <br /> N0. TYPE Of FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handlin� uni�s <br /> Bathlub Forcod iir syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water hoaler <br /> Kitch�n sink 8 disposnl _ Gas fireplace <br /> Dishwasher Gasranc�o <br /> Clolhes washor _ Clothes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/moplelc.) _ Exhausl fan <br /> Backflow preventer _ Heal pump <br /> Urinal Uni�healer <br /> Drinkin� Founlain _ Boilor <br /> Floor drain Rolrigeralion <br /> Greasr.lrap _ Woodstove <br /> Rool drains Other <br /> Olher <br /> �I' CITY OF EVERETT LOCAL SALES TAX CODE IS]105 <br /> I hereby ceritlly that I have read and examinod this applicalion and know the same to bo truo and conect. All provisions o!laws and <br /> ordinaces goveming Ihis lype ol work will be complied with whethr,r specified heroin or noL The granting a(a permil does nol prosume <br /> ilo�ive authurdy lo violato or cancel tho provision of any other stale nr tocal law rogulating construction or lhe paAormanco of <br /> construction. ihai I am authorized by the ownor of this propaAy to periorm the work lor which applicalion is made and I comply with the <br /> Sla�e Conlm��.i�ns�.aw iD.27 RCW qnd 29G.200 WAC. <br /> J �� / t <br /> � �—� _ �,.y //-�d"�� <br /> Siy lure of Owncr oNractodAuth�e�d.`Agen� Dale <br /> t,. <br />