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F �RMIT APPLICATIvN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEGAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org � `��_O� <br />APPLICATiUN3 ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT P.CCEPTEL <br />SITE ADDRESS PARCEL TAX I.D. # PE�!' # <br />� 1Z(� ��CcC�� �sl,�j-� <br />LEGA LOTNO. BLOCK TRACT <br />� � � `�' � /b <br />TENANTNAME � <br />CONTRP� T � �: <br />����J <br />CONTR. LICENSE k <br />USE (iF 6UILDING <br />WORK DESCRIPTION <br />��/�1��� �J`/� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Ba1hWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clo�hes washer <br />Laundry tray <br />Sink (serviceNadmop/elc.) <br />BackBow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof d;ains <br />Olher <br />�5�- f yy� <br />FOR PERMIT <br />ADDRESS � � CINIZIP <br />���� li� ��L6f �G�Cc'� C `�i%�'/ <br />J � <br />HEATSOURCE <br />Eleclric Gas Other <br />PHONE <br />PHONE <br />(,f25 >Sf' <br />Cn U /� �' <br />CONTRACT PRICE OF WORK <br />NO. I NPE 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 />Ezhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeralion <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceritify lhat I have read and examined this applicalion and know the same to be Uue and correcL Ail provisions of laws and <br />ordinaces c�ovemirg lhis type of work will be complied with whether specified herein or noi. The granting of a permit does not presume <br />to give aulhority lo viola�e or cancel the provision of any olher state or local law regulaling censWclion or lhe performance ot <br />construr,tion. That I am aulhorized by lhe owner of Ihis property to perform the work for which applir,ation is made and I comply with the <br />SlatA Ccnlractors Law 18.27 RCW a�d 296.200 WAC. <br />% � , ,� � � %c • -� �- -" — _ 5 - %C� ' L '.`_� <br />