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-� {J <br />PERMIT APPLIGATION <br />CITY OF EWERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />�2zs MA D�son1 fkvE <br />LEGA�L� LOTNO. BLOCK <br />DES�.I Z'�!'I30 . /Z <br />� <br />IPARCEL TAX I.D. # <br />OD54�y�-7o/ Z,oz-7oo <br />TRACT.. � /� <br />%�Gc� qG� -�nlo <br />G(-FRl$��^y�� �Hq4Tj� �-%riF,��l�✓G. ��lO �r35*`P!. S,W. -..,�ZSV218 iSZz <br />�Dr-ionl�5 WA. q9ez� <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />30(3 Gt}Rl5TSN5cN <br />CONTRACTOR pDORESS <br />G.+fRisTEr��J 6h-+a�rry 4-lo�'s, tuc. �7�0 ��5-*� Pl. Si.J. <br />PHONE <br />�Z5 Z/8 /Szz �DMon.t�s� Wh. 9soz.4 <br />PROPOSED USE OF BUILDING <br />�Nc�+..E FRM��yR�s��E <br />Bui�ding Mechanical <br />PERn7iT Combination R Plumbing <br />TYPE Demolition � Sign <br />Sprinkler <br />CONTRACTPRICEOFWORK � �53�"�'Z� po <br />vYVKR UtJGRIYIION <br />�ut�p A NE'�1 SIntG�E F/}titl�Y R,�s,�E <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLON/PREVENTER <br />SINK (SFRVICE/BAR/MOP/ETC.) <br />OTHER_ <br />�'�� 2f 8 /SZ2 <br />ZIP CONTR. L�CENSE # <br />GNRiS�N io7cfP <br />�AddiUon I HEA7SOURCE <br />Alteration Electnc <br />New Gas <br />Repair/Maint. Oth^r <br />CITY OF eVERETT LOCAL SALES TAX COOE IS 3105 <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIF'Y THAT I HAVE READ AND EXAMI�ED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SFcCIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OP ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE �VORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTR S LAW ?8.27 RCW AND 296.200 WAC. <br />� ._!L �/.� �% . , <br />DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />� <br />