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- - - - - -- _ � <br />l <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE AODRESS <br />i z r c� Et�tR�7T l`�Atc <br />LEGA LOT NO�. -�� BLOCK <br />oesc. o_oo o- o� I �z <br />PARCEL TAX I.D. N <br />TRACT <br />,7'KTERLiTY Pivisid <br />:^RM'IT w <br />W��-�� <br />-�i�� NrcLSEn! �031 �Iw 56r" �S'E 9�10� .zoc-�s.�-sysy <br />TENANTNAME CONTACTNAM[ PHONE <br />j Ao��ANTA6t c��2e[�ss t�kc' TqYLo� .3o3-Y�6-9o�Z <br />' COHTRACTOR ADDRESS LP CONTR.UCENSEM <br />I R�RN-K�YRF�'4iR�('IRiN7Er�AN�E `�1ooE(/ER�RL'-EN �/�4y T��x�noEHJJ <br />PhONE �/zS -,5 /�/-�/ S'/ Ev�ae�n wA 9Xzo3 <br />ce�c ti<S-3v4�- �75�0 -7ry i <br />I PROPOSED USE OF BUILDING <br />Building Mechanicel <br />PERMR Com6lnation Plumbing <br />TYPE Demolition Sign <br />Sprinkler (M ot hontls) <br />CONTRACT PRICE OF WORK ,$ L� C�'s`j �'�'�' <br />�Atl0i6on HEAT SOURCE <br />( Alloration � Electric <br />BNow Gas <br />RopaidMaint. Othor <br />CRY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />WORK DESCRIPT70N <br />�. f�DO � w�lLC FKo�y CowcRC-TF I=LaoiZ 'To Su.sFEN D�D CE�� �/VG <br />�. AOU AN qppi ii6n�,11 t.�,itilpoc� <br />NO. I TYPE OF FlXTUNE OH fTEM I�7 0� V CC <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (LVASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUhJTAIN <br />FLOOR DRAIN <br />BACKFLOV'JPREVENTER <br />SINK (SERVICE/BAR4.IOPiETC.1 <br />OTHeR <br />mc�.nnrvwA� /\� p N � <br />N0. I TYFE OF FI:.TURE OR REM <br />A/C - M IANDI_ING UN�TS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT H[ATERS <br />CLOTHES ORYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />' GI1S RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBV CERITIFY THAT I HAVE READ AND EXAIlItJEO THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDIMACES GOVERNItJC, THIS TYPE OF WORK WILL BE COIdPLIEO WITti WHEThfER SPECIFIED NEREIN OR <br />ti07. TNE GRANTIPIG OF A PERIAIT DOES NOT PRESUI�IE TO GIV[ �IUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR LOCAL LAVf REGULATItlG CONSTRUCTIO'! OR THE PERFORMANCE OF COIJST(iUCTION. THAT I AM AUTHORIZf-D DY THE <br />OYINER OF THIS PROPERTY TO PERFO�A THE WORK FOR WHICH APPLICATIUN IS MADE AND 1 COMPLY WITIi TI1E STA7L' <br />CO��TRACTOBB'�Y! 18 27 FCVJ ANj)25�a/100 WAC. <br />.� //,,/D� <br />Dato ��L <br />