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NERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 S-17 �"06 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FRONf 8 AM TO 4 PM a �(,P �S ' U� L' <br />SITE ADDRESS �%/�� �j ('I A2 :) F50/Vf� D PARCEL TAX I.D. p <br />y �.�: }?Y D EJ� � r rl r,v,3- �I4Z�a4 I <br />LOT NO. I BLUCK I TRACT <br />�� ,,, , <br />IANT NAME ��/��� �� �,� N/r � CONTACT FOR PERMIT <br />ti ���v� <br />:ONTRACTOR C ✓L /�C7"YZr� �j/J)/S% ADDRESS'1(',�v <br />J� <br />CONTR.LICENSEp �j y�' V2CL ���C� Y�N <br />USE OF BUILDING <br />l���r�u f S�w�' <br />HEATSOURCE <br />PERMIT# _ � <br />%�'1 (C � ' � ' � <br />PHONE <br />(�lzS� 3��- aSr� <br />CITY2IP <br />�"�AC;.F; c Q L <br />_ Electric � Gas _ Olher <br />PHONE � �j)�T�Cg-5��i'� I <br />'1���,W�- `7 S�� 5 <br />CONTRACT PRICE OF WORK <br />%S��Q� � <br />WORK DESCRIPTION -/� -// / �h In/ � /� <br />�C..G( FvlCj.�� ���'�d' //=�l�t N I �7GL� A� �C�Vt.il /"!�t LGZl1 Ltf CG� <br />U <br />� r �� ��� rf� <br />NO. � TYPE OF FIxTURE OR ITEM <br />� <br />�. <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washcr <br />Waler heater <br />Sink (servicelbar/mopletc.) <br />Backflow 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 unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer. � <br />Range hood / yJ � <br />Exhaustfan � <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />L � °-, �� <br />. <br />I hereby ceriti(y that I have read and examined this application and know lhe same to be lrue and correcL All provisions ot laws and <br />ordinaces ooveming this type of work will bo complied with whelher specified herein or nol The grantiny of a pertnit does nol presume <br />to give authority to violate or cancel Ihe provision o( any olher stale or loca� law reguialing construclion or lhe performance of <br />conslruclion. That I am aulhorized by lhe owner of lhis property to per(orm the work for which applicalion is made and I comply with the <br />Slale Conlractors Law 18�7 RCW and 29fi.200 WAC. <br />UGC��'__ %JS�a ��DG, <br />