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PtRMii APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-88'� C— FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM P AM TO 4 PM <br />2ESS ,(' / n PARCEL TAX I.D. # <br />�y..� I � I" / l�C.�� > ���D(� :���' <br />� �a r r <br />LOT NO. BLOCK TRACT OR SUBDIVISION # <br />zr — �:. o� 1�-, � t� c� of -�-. � h, s?`� <br />v('�1���, <br />TENANTNAME <br />CONTRACTOR <br />CONTR ,LIC�N�E # <br />USE OF BUIL['ING <br />� <br />i•a/-��AI�E <br />WORK DESCRIPTION <br />� � <br />. <br />(it,��� �-C/1� <br />rt.�.!• .. , <br />. r � � ♦ � �. . _ � . <br />Ol1U� i <br />FOR PERMIT <br />•. <br />ADORESS <br />. �. -� -�'��j, <br />. . L. �� <br />SOURCE <br />6-�� <br />PERMIT # <br />��� �✓C� C'� <br />�'l� C.,�-� �}� �a� <br />.f PHONE <br />� , , `/2� � ?`�`��'`�: <br />�•• . <br />• , •, <br />CITY2IP PHONE <br />� � t� :� � � • �� �.1.�.� <br />� <br />_ Electric _ Gas _ Other <br />� � /� / n <br />.. '-�c� �l�(.�/,-��i�C.� �.�1�%"/ <br />PLUMBING <br />NO. I TYPE OF fIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Back(low provenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />4�S'U <br />NO. I TYPE OF FDCTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiier <br />Re(rigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SA! ES TAX CODE IS 3105 <br />I hereby ceritify lhat).hava�ead and examined this application and know the same to be lrue and correcL All provisions of laws and <br />ordinaces governing lhis ryp� of work will be complied with whe0ier specified herein or not. The granling of a pertnit does nol presume <br />to givc+ aulhority t'o violate or Eancel the provision of any othcr state or local Iaw regulating construclion or the peAortnance of <br />const��ction That I am authorized,byl e Wrtel o( lhis property to perform the work for which applicalion is made and I comply wilh the <br />SlatC Coniractors�Law 1827 R and 29620d WAC. <br />�I; ��% _ _ � �-����U� <br />