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SITE ADDRESS <br />� 21 tJ-`�I�� <br />LEGA LJT N0. <br />DESC. S 1� � SI� <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 />� PARCEL TAX I.D. # <br />u-1,�c. S[���_004- Cb2- ozsn <br />BiOCK TRAGC� �`�' _ 1 �' �� <br />� �yy..Ly , 1 1 <br />TENANTNAME <br />fJ R <br />CONTRACTOR <br />CONTR. LICENSE N <br />rJ R• <br />USEOFBUILDING ���(�� ������✓ <br />7 <br />'�c� <br />WORK DESCRIPTION <br />N0. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etcJ <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other <br />2 � �Ta �A/ J� I.hs <br />CONTACT FOR PERMIT <br />� v���� � <br />ADDRESS <br />NEAT SOURCE <br />_ Electric � Gas _ Olher <br />l� <br />(l/ W � . Q <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />� o cba <br />NO. � TYPE OF FI%7URE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas firoplace <br />Gas range <br />Clothes dryer <br />_ Range hood <br />Exhaust(an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same lo be lrue and correcL All provisions of laws and <br />ordinaces governing lhis type of work will be complied wilh whether specified herein or nol The granling of a pertnil does not presume <br />to givo aulhoriry to violale or cancel tho prowsion of any other slale or local law regulating consWction or the performance of <br />conslruction. Thal I am autharized by Ihe owner of Ihis property lo perform the work tor which applicalion is made and 1 cemply wilh the <br />State Cont�ors}a�27 CW and 296.200 WA0. r /� <br />� /, ' $(2��0 <br />�IL <br />�� <br />