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� <br /> RERMIT 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 /> I� <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT p� - G,D� <br /> i� ia� �� l'��'� c �� <br /> LEGH LOT N0. BLOCK CT OR SUBOIVISION N <br /> DESC. <br /> OWN'E/R ADDRESS CITYIZIP PMONE <br /> /� \Q � U/ - <br /> TENAN NAME CONTACT FOR PERMIT PH/ONE✓�7 i� <br /> I O/)L.. �(J' CO Z Z� E-M�L] :S <br /> Z`�N'IRACTOR DRESS C I HO E <br /> CONTR.LICENSE N / „ L[�/y� J " '_` �Q(�{f� <br /> l�(/JJ 4 –_� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> `Electric _Gas__Olher <br /> WORK DESCRIPTION . <br /> /� a..�c� 3 o y � ���ti- �(�'�' <br /> PLUMBING MECHANICAL <br /> N0. � 1YPE OF FIXTURc OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet � NC–air handli�g units <br /> � Oathlub �/ � Forced air systems <br /> Lavalory(wash basin) � �� Gas pipint� <br /> Shower Walen c�aler <br /> � Kitchen sink&disposal Z Gas fireplace <br /> � Dishwasher Gasranye <br /> � Clothes washer � Clothes dryer <br /> _ Water heater � Range hood <br /> Sink(service/bar/mop/elc.) Eshaust fan ��// <br /> Back9ow preventer _ Heat pump <br /> Urinal _ Unil healer <br /> _ Drinking Founlain _ 6oiler <br /> Floor drain __ Refrigeralion <br /> Grease trap _ Woodslove <br /> Roof drains _ Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and ezamined this application and know lhe same lo be We and correcl All provisions o(la�vs and <br /> ordinaces goveming Ihis lype of work will be complied wilh whether specified herein or not.The granling oi a permit does nol presume <br /> to give aulhority to violate or cancel the provision of any olher stale or local law regulaling conslruction or lhe peAormance o( <br /> construction.Thal I am aulhorized by lhe owner of this pmpeAy to perform the work�or which appiication is made and I comply with the <br /> Slate Conlraclors Law 1827 RCW and 296.200 WAC. <br /> ��/`/�l�b� <br /> SignaWre ol Owner/Coniraclor/Aulhonzed Agenl U t—�– I <br /> 1 Z <br />