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PER�VIIT 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 />SITE ADDRESS <br />�C7 � <br />LEGA LOT NO. BL( <br />DESC. <br />OWNER <br />TENANTNAME <br />I��NII T���� <br />CONTRACTOR „l� � <br />i��� � �, `I' < <br />CONTR. UCENSE tt�//`T�IS'k1 S <br />USE OF BUILDING —T� <br />WORK DESCRIPTION <br />c;�s �,�J� <br />NO. I TYPE OF FI%TURE OR �TEM <br />Toilel <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (servicelbadmop/elc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT FOR PERMIT <br />�.�AN1�'s �� 1�4� <br />� •-� �—O6 <br />PHONE <br />3s.�-�/�3 <br />I _ADDRESS `�CITY2IP PHONE�� �� <br />� �� o P�x �s3� 7�.�;1�. �3,1�� /�-3 <br />HEATSOURCE <br />Eleciric Gas Other <br />N0. <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas firepiace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ccritify Ihal I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br />ordinaces goveming this lype o( work �vill be complied wilh whether specified herein or not The granting of a permit doos not presume <br />lo give aulhorily lo violate or cancel the provision of any other slate or local law regulating construction or the performance of <br />construclion. Thal I am authorized by the owner ot this property to perform the work for which applicalion is made and I comply with ihe <br />Stale Con c rs Law 18.27 RCW a/nd 296.200 WAC. <br />% ��/�/.�0� ����"�� <br />..r � � ---,� * ��� , <br />