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Aus. 29. 2011 9:OBAM Rc. Q�86 P. 3 <br /> -: <br /> P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX k25-257-8857—www.everettwa.org <br /> APPLICATIOPlS ARE ACCEPTED FROM 8 AM TO 4 PM g—�'�� ( <br /> SI7E ADURESS pARCEL TAX I.D.# PERMIT M <br /> ��o� }b �R�JL Ev g zo 1 <br /> LEGA LOT NO. BLOCK TflACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> ��i�.rd.0 saxKo,� �125 3�1�3883! <br /> TENANT NAME CONTACT FOR PERMIT PHONE. <br /> E�M1tAIL <br /> HAC OR <br /> 4muea�inqlnL 1�4�5 Brood�(�SS� as�o� °T" �F25 �.�q6��� <br /> CONTR.LICENSE d <br /> C'.m++� oq�,Ry <br /> USE OF BUILDING HEnT SOUHCE CONTRACT PRICE OF WORK <br /> I — n I <br /> Elecvlc �Gas_Other �Q�43 •Q (� <br /> WORKDE$CRIPTION ��5��` �a� -�vrn�-- <br /> PLUMBING MECHANICAL <br /> N0. Np�OF FlJ(TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet PJC—airhandlingunits <br /> � Balhtub � Forcodairsystems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen slnk&disposal Gas fireplace <br /> _ �ishwasher Gas range <br /> _ Clothes Washer Clothes dryer <br /> _ Water heater _ Fiange hood <br /> Sink(servtceroadmop/etc.) Exhaus�fan <br /> BacklloW preventer Heat pump <br /> � Urinal Unil heater <br /> Drinking Fountain 9oiler <br /> _ Floordrain Refriperation <br /> _ Grease�rop WoodstgYe <br /> _ R��Oedralns � Other �1-U1'11� <br /> CITY OF EVEFiETT LOCAL SALES TAX CODE IS�705 <br /> I haraby ceritity thal I have read and examined this application and know lhe same to be true and carrect. All provislons of laws antl <br /> ordinacos poverning this type ot work wltl he complied with whether specilied herein ar not.The granting of a permit does not presume <br /> to give authority to violale or cancel the provlsion of any other state or local law regulating constructlon or the performance of <br /> constructlon.That I am aulhorized by lhe owner ot this propeny to perform thg work for which application is made and I compiy wilh the <br /> Siate Coniractors Law i8.27 RCW and 296.200 WAC. <br /> 17e,baai� I�.��a� 8•�q•tl <br /> SIg�eW��of Ow�CdConlraQoqAulhOnZB ent Date <br />