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PEF�MIT APPLIC�TION <br />CITY OF EVER�TT PERMiT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8t310 — FAX 425-257-8857 — www.everettwa.org <br />�.,,� P�-� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -.;-�' <br />SITE ADDRESS PARCEL TAX I.D. # PE MIT # <br />�2"J 1-•r���� %�Oj-lv <br />LOT NO. I BLOCK I TRACT OR SUBDIVISION # <br />DESC. <br />TENANTNAME <br />PERMIT <br />-3�3-/ <br />PHONE <br />CONTRACTOR ��V� 5�����E �/�yjADDRESS 8� (��� CITY2IP PHONE <br />�tfN,/sO'✓ �/L5 = 3 �'i <br />CONTR. LICENSE # � 0 � � <br />. /J!%✓ P1—`�'��G � S�.Sd� <br />USE OF BUII.DING <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />�_ <br />Toilet <br />Ba�hlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dislnvasher <br />Clalhes washer <br />Water heater <br />Sinlc (scrvicc/bar/mop;etc.) <br />Back(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other <br />HEATSOURCE <br />Electric � Gas _ Olher <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity thal I have read and examined this application and know the same to be lrue and c�rrect. All provisions o( laws and <br />ordinaces governing this type of work will be complied with whether specified herein or nol. The granling oF a permit does not presume <br />lo c�ive authority lo violate or cancel the provision o( any other slale or local law regulating construction or lhe performance ot <br />consUuction. Thal I an authorized by the owner of this property lo perform the work for which application is made and I wmply wilh the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />' j -'G.:c�����7�� --J� //— � � U�' <br />