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P�.RMIT Q,PPLICATI(��V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9820' <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />�,����°� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - D�BIT 2!� CREDlT CARDS ARE NOT ACCEPTED <br />SITE A DRESS <br />� <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />BLOCK <br />PARCEL TAX I.D. # <br />ICONTACT FOR PERMIT <br />AUDRESS <br />HEATSOURCE <br />PERMIT # <br />���. ^ <br />PHONE <br />CITY/ZIP PHONE <br />. <br />' -�r'73�G� <br />I CONTRACT PRICE OF WORK <br />Electric Gas Other <br />.��� ������ <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes w-.sher <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backilow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain � <br />Grease-irap ^ <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <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 hRater <br />Boiier <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CO�E IS 3705 <br />i hereby cerilify that I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to give auth �ity to violate or cancel the provision of any olher state or local law regulating construction or the performance of <br />constructi �That I a uthori d by the owner of this property to perform the work for which application is made and I comply with lhe <br />V e�� 'C./)ii�ll7�l 1'�12! .(JlX.�fl/'� A/.20�i Y ��/�� <br />� <br />