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SITE <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www•everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �—� �`— I I <br />LOTNO. V I BLOCK <br />� � PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />PERMIT # <br />i�IIJ�� 0�� <br />TENANT NAME CONTACT FOR PERMI PHONE Z'$•7�9 <br />1��F4 I VWJ\L4.J������ 1 E•MAIL `�VSICAI'_CYO�Y <br />�ir�e 1��2c.�}-�oh,1h�"�'j`�o�C l2113 <br />�e; ` NZS�`l�l• <br />c�o`wN FPo4yt-L �6�a� <br />USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric _ Gas _ Other � ��� �• � <br />WORK�SW+'�N� /� r�nkler S S�el <br />l�.i v'.2 S r�n�2r Gi°Q�S •/�eGc� w� Sj� % <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory jwash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwashcr <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/5 <br />Urinal <br />Drinking Foi <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handlinc� units <br />Forced air systems <br />Gas piping <br />� Water heater <br />Gas fireplace <br />_ Gas range <br />Clothes dryer <br />_ Range hood <br />Exhaustlan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Waodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and exam!ned this application and know the same to be true and correcL All provisions of laws and <br />ordinaces governing this type of work will be complied wilh whether specilied herein or not. The granting of a permit does not presume <br />to give aulhorily to violate or cancel the provision of any other slate or local law regulating construclion or the performance of <br />consiructi That I am authorized by the owner ot this property lo perlorm the work for which application is made and I comply with the <br />State nV ctors Law 1827fjCjN �nd 296.200 WAC. <br />l�� <br />