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SITE ADDRESS <br />� 2U'j C.�e1 <br />LEGA LOi NO. <br />DESC. <br />� ERMIT APPLICAT<�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />r-1 W H `� <br />BLOCK TRACT <br />PARCEL TAX I.D. � <br />�J <br />13TC.t, DJESEN"g�7Zh <br />TENANT NAME CONTACT NAME PHONE <br />�T-�r-r-i-F c-,y� I KF_r�1 k����zec-�r Zo�-G3� -1140 <br />CONTqqCTOR AOORESS <br />µ-ItZCU ENT�'7LD213�5 �.t[ Zq53� �(� L�5T1-1 WRy Z�P CONTR.LicENSE# <br />P�� n3� -� �n <br />PROPOSED USE OF BUILDING <br />� �-1.�t. R 2ttJ S �� `�y'�t.l <br />CONTqACT PRICE OF WORK ��S <br />WORK DESCR�PTION <br />1\1t�W Rl3ST�00W1S <br />N0. � TYPE OF FIXTURE OR ITEM <br />L WATER CLOSET <br />_ BATHTUB <br />� LAVATORY(WASH BASIN) <br />SHOWER <br />� KITC!iEN SINK 8 DISPOSAI <br />_ DISHWASHER <br />_ LAUN�RY TRAY <br />_ CLOTHES WASHER <br />URINAL <br />� DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />BACKFL.OW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />= OTHEFY�CE MP11Cci� • <br />�ss�ru�,u w� qQ�62q M1AL-ZCUEZOSEi�lL <br />Building <br />PERMIT R Combinalion <br />TYPE � Demolition <br />Sprinkler <br />Gt? <br />�Mechanical <br />Plumbing <br />Siyi <br />Addition <br />Alteration <br />New <br />fiepair/Maint. <br />HEATSOURCE <br />�Eleciric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� 1�'S.TC}�.t_�1 'F02 <br />NO. I <br />L I-I .LZ D(L c�-J S C� v�'l. <br />TYPE OF FIXTURE OR ITEM <br />fvG — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACFJSTOVE <br />rIFEPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE HFAD AND EXAMINED THIS APPLICATION AND KN06Y THE SAME TO BE TRUE AND COFRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVER�!ING THIS TYPE OF WOFK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />S7ATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE PERFOAh1ANCE OF CONS7RUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER O'� THIS PROPERIY TO PERFORM THE WORK FOR WHICH APPLICATION IS h1A0E AND I COMPLY WITH THE STATE <br />CONTRACTOPS LAW 18.27 RCW AND 296.200 WAC. <br />