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SITE ADDRESS <br />LOT NO. <br />TENANT NAME <br />S�/ "�� <br />G�/.f' <br />c. <br />� <br />�_ <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />�RCEL TAX I.D. # <br />�-Gdl- oav - O D <br />TRACT OR SUBDIVISION # <br />3/Q �7 C�t1� j�AV� 9�ZU/ t/�S. ��3. //Z/ <br />CONTACT FOR PERMIT ��r�n�, 6s' ! 6 <br />,�0� /�✓ ��/� E-MAIL <br />l:Vnln/��.ivn �/ <br />F//�.��� </�C�f/N� fit/%���'t � <br />CONTR. LICENSE # <br />USE OF BUILDING <br />S�'.� <br />HEAT 5 RCE CONTRACT NRlct ur wurcn <br />_ Electric Gas ,_ Other , /���Q_ <br />WORK DESCRIPTION <br />����/�/i�S�D��I E^.Y/fT/'�� ,e�`r/�E"�✓�'� <br />N0. I TYPE OF FIXTURE OR �TEM <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 />Backtlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Farced air systems <br />Gas piping <br />Waler heater <br />b�s fireplace <br />CI es dryer <br />nge hood <br />Exhaust fan <br />Heat pump <br />Unil heater <br />ao S��j�D <br />Refrig n � <br />Wo to <br />er ��� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined lhis application and know ihe same to be true and correct. Ali provisions of laws and <br />ordinances governing this type of work will be complied wilh whether specified herein or not. The granGng of a pertnit does not presume <br />to give authorily to violate or cancel the provision of any olher slale or local law regulating wnstruction or the pertortnance of <br />construction. That I am authorized by the owner of this property to perform lhe work for which application is made and I comply with the <br />Slale CyrytCay(ors Law 18.27 RCW and 296.200 WAC. <br />