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SITE AD�1 RESS <br />//Z�/ <br />�� <br />LEGA LOT NO. <br />TENANTNAME <br />r , <br />PEr�MIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-b810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I/� —T/ 7 <br />� S� <br />BLOCK TRACT <br />CONTRACTOR ^ ���� r� r <br />�j,�7/EySC,e��CL' q�''l(,'_ <br />CONTR. LICENSE N <br />�J��y�ss�r� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />����,��.� <br />PARCEL TAX I.D. # <br />��LL <br />ICON ACTFOR <br />ADDRESS <br />✓� ,6� � <br />s� <br /># <br />'%01- 7 <br />CITY2IP PHONE <br />`1��.�+- �� �� � <br />359- 60%� <br />HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric Gas Olher <br />d (.<.,���C� � 11 ��-�-- <br />NO. I TYPE OF FIXTURE OR �TEM <br />� <br />� <br />Toilet <br />BalhWb <br />Lavat�ry (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/badmopletc.) <br />BackOow prevenler <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 units <br />forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryor <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 ceriti(y lhal I have read and examined lhis applicalion and know lhe same to be true and coRect. All provisions of laws and <br />ordinaces c�overning this type of work will be complied with whether specified herein or not. The granling of a permit does not presume <br />to give authoriry to violale or cancei lhe provision of any olher state or local law regulaling wnslruction or the pedormance of <br />construction. That i am aulhorized by lhe owner of Ihis property to peAorm the work tor which application is made and I wmply wilh the <br />Slate Conlractors Law 18.2�7 RCW and 296.200 WAC. <br />� <br />