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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR. STREET, EVERETT, WA 98201 <br />125-257-8810 — FAX 425-257-8857 — wwvd.everettvva.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 Plr <br />SITE ADDRESS�D ///vac, / <br />LEGAL LOT NO. C BLOCK <br />'�1✓/ <br />PARCEL ADO -DOD <br />TRACT OR SUBDIVISION # <br />OWNER AUUntb <br />C/p,e �/% f/ads�i✓� sf1�TH�P�T/ � Coc�yf'd� �dC�6TT c/ZS.3o3.//Z/ <br />9.PZ o <br />TENANT NAME CONTACT FOR PERMIT ,?R`NE <br />E-MAIL <br />CONTRACTOR ADDRESS CITYIZIP PH::�.'f—E— <br />F(/� /rET �Gdl�/�/G A vT/�arC/Ty. <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOJRCE CONTRACT PRICE Ur WORK <br />Electric 'as _ Other ( 0 �-- <br />WORDESCRIPTION �s/��/ <br />wi�daws� wA4 <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Cr.nking Fountain <br />Flour drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give uthority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />constru�c Ion. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />crPlP r, arlors Law 18.27 RCW and 296.200 WAC. <br />