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SITE ADDRESS <br />,�� �'G <br />LEGAL LOT NO. <br />DESC. <br />OW <br />��r � <br />TENANTNAME <br />CONTRACTOR <br />CONTR. UCENSE it <br />PERMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />G /f/?d/,/ <br />BUILDIN�. <br />T �.��� <br />PARCEL TAX I,D. # <br />l' ' -- - <br />rnncT �Yr��/U <br />ADDRES 7 <br />J `By �2� / <br />CONTACT FOR PERMIT <br />ADDRESS <br />HEATSOURCE <br />_ Eledric � Gas _ Other <br />WORK DESCRIPTION������ /�L �/^� <br />y <br />�d"T �it''/��T�` ��r'E <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shovrer <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry lray <br />Sink (service/barlmop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Rool drains <br />Other <br />NO. <br />�b �a5-O6 <br />PHO E <br />ys;��'.,�v>�_���� <br />CRY/DP PHONE <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Re�ngeration <br />Woodstove <br />ONer <br />C�TY OF EVERETT LOCAL SALES TFU( COOE IS �105 <br />I hereby centify thal I have read and examined ihis application and know tha same to be true and wrtecL All provisions o( laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The granUng of a permit dces not presume <br />to give authonty to violate or cancel the provision ot any other state or loca� law regula6ng wnsWdion or the perfortnance of <br />wnstrucUon: al I am auth i by t�ywn Of this properry to pedorm the woric for which application is made and I mmply with the <br />State C IXors Law 18. an dWAC. , / <br />