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� <br />ERMIT APPLICA�ION <br />CITY OF EVERETT PERMIT SEF2VICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 bL�, �(�v 5 v3- <br />SITE ADDRESS <br />I U S s� � ���G�IT <br />LEGA� LOT NO. BLOCK <br />DESC. <br />TENANTNAME <br />CONTRACTOR <br />L <br />PHONE <br />PROPOSED USE OF BUILDING <br />��JLL <br />PERMI7 <br />TYPE <br />CONTRACTPRICEOFWORKr�Uc�� �C�U <br />WORK OESCRIPTION <br />PARCEL TAX I.D. # <br />ICONTACT FOR PERMIT <br />ADDRESS <br />21P <br />PERMIT # <br />PHONE <br />CONTR. LICENSE # <br />CLi�T� eGD2oC/� <br />BUilding chaniCal Additlon HEATS �CE <br />Combination Plumbing WORK terauon Eiecvic <br />Uemolilion Sign TYPE New Gas <br />Sprinkler RepaidMalnt. Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />/l� /L-A'0 V.J � �F4 �i ��-V �✓�'��ilJ� /'�'� <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSHL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLUOR DR,41N <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER�2��o4C�f /•uf,SKWP'FU�2 <br />��n .I-t�,N�s C,�rw�.�.,��. <br />A/C—AlHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREP�CE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAA1E TO BE TRUE ANJ CORRECT. ALL <br />PROVISIONS OF LAWS AND OP.IDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED OY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC/�RS LAW 18.27,ffCl'V�1ND 296.200 WAC. <br />CARDS ARE NOT <br />