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PERMIT APPLICATI(3N <br /> CITY OF EVERETT PERMIT S�RVICES q <br /> 3200 CEDAR STREET, EVERETT, WA 98201 -� - �l `' / <br /> 425-257-8810— FAX 425-257-8857—�r�ww.everettwa.org ;�/� �� � `" <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ' 'Z _)(� .�� <br /> SITE ADDRESS PARCEL TAX:.D.# �PpER—M7IT# <br /> /C' O �1GEi itet� W l�� / �� J �_ <br /> LEGAL LOT N0. BLOCK TkACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Oco�, ���;,,; 79LS v��errr,�C���4�.r . 9��� <br /> TENANT NAME CONTACT FOR PERMIT PHONE .l,Lr 7���3�� <br /> / / Y" <br /> Z/`I�M ZKv7'1 �I M��� c�,�CGG E-MAIL <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCF CONTRACT PRICE OF WORK <br /> Electric Gas Olher <br /> WORK DESCRIFTION <br /> U�j�� � ��� �,� �%�.,�o�-�rs��.� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> _ Balhtub Forced air systems <br /> Lavalory(wash basin) l� Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Gishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Reirigeralion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> — �� �����(f/�fh%ifb� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces goveming his type o(work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> lo give aulhority� iolate or cancel lhe provision of any olher state or local law regulating construction or lhe perionnance of <br /> conslruction:Tha am autho�ized by lhe owner of lhis property to perform the work for which applicalion is made and I comply with the <br /> Stale 6ntrac r Law,18.z7 �W and 296.200 WAC. <br /> ,_ j /�, <br /> � <br /> Si at�7re of wnedConlractor/Authorized Agent Dale <br />