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P�.3MIT APPLICATIC�`.. � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 -FAX 425-257-8857 <br /> 5{'fE ADD ESS � PARCEL TAX I.D.K PERMi7 x <br /> �j���' �-� ��N�.110Q� D04 - ?G�'-G�oc7a - ►`rol L -oa� <br /> LEGAy LOT NO. BLOCK TRACT <br /> oesc. DU O <br /> OWNFR ADDRESS ZIP PNONE Z� � <br /> L,4�1 C� !?��CKMAr`l 75G I 217�' �j, 1 �D�nOfJDS ��b7v �7�.-8�r�3 <br /> TENAPIT NAME CONTACT NAME PHONE <br /> � I kR�57iN NAt�DN dz5 -�74�71Z`� <br /> CONTRACTOR �RI�`�l. C��S /� ADDRESS ZIP CONTR.LICENSEM <br /> �50� 21� Sf �pMo�UDs- <br /> PHONE �{� , ���' A JD� ���� <br /> ��� �) <br /> PROPOSED USE OF BUILDING Building Mechanical � Additton HEAT SOURCE <br /> PERMIT � Combination Plumbing WORK Alteiation I7 Electric <br /> ]�(�"j���� TYPE Demolilion � Sign TYPE New AGas <br /> V �� � Sp�i�kl2f Repair/Maint. V Olher <br /> CONTRACT PqICE OF WORK ,�(n7 ' �/ CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION <br /> ,N�w ��P��� I c� �y� �5 �s�� �+: ��r uc�i=f�- , _ : <br /> ��� � � ��+� �r� -� cc��� i � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR REM NO. TYPE OF fl7(TURE Op ITBM •� • ' <br /> WATER CLOSET (// A/C-A/HANDLING UNITS <br /> � BATHTUB ( / rL FORCED AIR SYSTEMS <br /> G LAVATORY(WASH BASIN) //� _ HEAT PUMP � <br /> �_ SHOWER / UNIT HEATERS <br /> � KITCHEN SINK$DISPOSAL L CLOTHES DRYER <br /> _� DISHWASHER � RANGE HOOD <br /> � �_ LAUNDRY TRAY • _� WATER HEATER <br /> i 1� CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> i iC_ URINAI. ti FIREPLACE INSERT <br /> �- DRINKING FOUNTAIN _'fL GAS FIREPIACE <br /> I _� FLOOR DRAIN Z GAS RANGE <br /> BACKFLOW PREVENTER �`- GAS PIPING <br /> i � SI�K (SERVICElBAR/MOP/ETC.) _� EXHAUST FAN / �// <br /> _ OTHER _ OTHER <br /> i — <br /> I HEREBY CERITIFY 7HAT I HAVE RF�1D AND EXAMINED THIS APPLICATION�ND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L4W5 AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETFiER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISION OF ANY OTHEF <br /> STATE OR LOCAI LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> , OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMFLY WITH TNE STATE <br /> iCONT�^'C�TO� _ LAW 78.27 W AND 296.200 WAC. <br /> ' �iw.����1 ��I��SU � �l�12�zav'L � <br /> ; Signalure ol OwnerlConlractor/Aulhon d Ag t Date � <br /> ' l <br />