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�� <br />� <br />SITE ADDRESS <br />5s �/ `/ ! r;�, �Qe�� <br />IEGA LOT NO. <br />C� <br />TENANT NAME <br />PE�`l�MIT APPLI�,AT14,J <br />CITY QF EVERETT PERMIT' SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK I TRACT <br />��`�J-t�.i <br />PARCEL TAX I.D. # <br />CONTACTNAME <br />�—S�—OZ� <br />7MIT u � <br />.�a��- � � �� <br />PHONE <br />CONTRACTOR �- ADDRESS . ZIP CONTR. LICENSE k <br />�j�� �, 5c�;�vr<< �+�,',t/'`'r��l�G- �r/i/ (</��dn�e2LE,�e �:� ��'`���cl <br />PHONE , / L � � �S S " % � rl �l `" /; <br />�t � riV L S J � / � S (J ,!3 <br />PROPOSED USE OF BUILDING Buildi�g � Medianical Q Addi�ion HEAT SOURCE <br />PERMIT R Combinalion Plumbing WORK yjA Alteration � Electric <br />TYPE D Demolilion Sign TYPE D New Gas <br />U Sprinkler U qepavRAaint Other <br />CONTRACT PRICE OF WORK CITY OF EVERETT IOCAL SALES TAX COOE IS 3105 <br />WORK OESCRIPTION <br />�. NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK S DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PAE`lENTER <br />SINK (SERVICEiBARIMOPIETC.) <br />OTHER <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FURCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIP,EPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CEFITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECI'. ALL <br />PROVISIONS OF WWS AND OfliDINACES GOVERNING THIS TlPE OF WORK WILL 6E COMPLIED WITH WHETHER SPEGFIED HE'nC!P! OR <br />NOT. THE GRANTING OF A PERMIT DOc`5 NOT PFESUIdE TO GIVE AUTHORITY TO VIOLATE OR CANCEI. THE PROVISION GF ANY OTHER <br />STATE OR LOC'1l LAW FEGULATING CONSTRUCTION OR THE PERFOAh1ANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br />OWNEA OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS 61ADE AND I COMPLY WITH THE STATE <br />COM1'TRACTOflS LAW 1827 RCW AND 29fi200 WAC. <br />2'i�,� %JF'/i-•��:a �-:J � _.j"_�J 7� <br />