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SITE ADDRESS <br />� �: � <br />LEGA LOT NO. <br />TENANT <br />CONTR. LICENSE # <br />U5E OF BUILDING <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wuvw.everettwa.org <br />�� <br />APPL!CATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLOCK � TRACT OR SUBDIVISION # <br />C�lSf �b <br />WORK DESCRIPTION <br />�-�7-I�I FIC� tjy�Tui7 5 <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />-% Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drain�,. <br />�y_ Other �'����� <br />CONTACT FOR PERMIT <br />4DORE55 �_ J�7 '!I '.y,1 <br />� -'- <br />�sN�r �� s <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />PHONE <br />�-o �� <br />��Y�- `�� � <br />�(L_ �;2� �0� <br />j"-o rZ <br />� 1�T�� " b0� <br />CONTRACT PRiGt c�r �rvurcn <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know lhe same to be true and correct. Ail provisions of laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give aulhoritK.to violate or cancel lhe pravision of any other state or local law regulating construction or the perfortnance of <br />construction. T�"I am authorized by the owner of this property to perform ihe work for which application is made and 1 comply with the <br />Stale Contract�r Law 18.27 RCW and 296200 \NAC. <br />�--': ,�9'�. ���[JJ%) <br />