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SITE ADDRESS <br />�=.�i�L � .�'1,C . <br />LEGAL LOT NO. I <br />DESC. . 1.. o ,; C /L• �i <br />OWNER <br />U 1�l c)1U <br />TENANT NAME <br />IAi � G �Lc„�� <br />CONTR. LICENSE p <br />— W.'f- �. �c �J <br />USE OF BUILDING <br />�� �k r c c.-� � <br />��.'ERMIT APPLICAI �ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wwHr,everettwa.org <br />APpLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />( , <br />� S h�'tn C� 0 n <br />�/� L <br />'t--� ✓� .,-a� <br />PARCEL TAX I.D. # <br />� ii� 1��� �' noosQ� �o!i <br />TRACT OR SUBDIVISION p <br />CONTACT FOR PERMIT <br />A��� W IC-+� <br />�P RM17# <br />��(/o� � Q��7 <br />'NONE �� ,, �y 6 <br />�% R- � :i� 2r. : <br />PHONE ��� 7 / S 6 ,, � <br />����� <br />i9�o� `���`'�J�,�2 �7�� e,-, s � <br />HEATSOURCE <br />�Eleclric _ Gas _ Other <br />WORK DESCRIPTION <br />�-� � � �'1 D r� /�Sl� � _ j� <br />%� SIr��G�`.:. I�ANti�y �2�S�DizniCE <br />DI I liuo�u� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Ii onei <br />Dalhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposaV � - <br />Dishwasher � <br />Clo�hes washer ' <br />Water healer <br />Sink (scrvice/bar/mop/etc.) <br />6ackflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease �rap <br />Roof drains <br />Olher <br />CONTRACT PRICE OF WORK <br />2,v,v�c� ,/r� <br />No• I TYPE OF FI%TURE OR ITEM <br />_L <br />_ rv� - air nanaimg units <br />_ Forced air sys�ems <br />_ Gas piping <br />Water heater <br />_ Gas fireplace <br />_ Gas range <br />_ Clothes dryer � ,J� �,� <br />Range hood <br />!— Exhausl fan <br />Heal pump <br />� Unil heater <br />Boiler <br />_ Refrigeration <br />_ Woodstove <br />_ Olher <br />CITY OP EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby certi(y thal I have read and examined this application and know Ihe same to be true and correct. All provisions of laws and <br />xdinances governing ihis type of work will be complied wdh whether specified herem or not The granting o( a permit does not presume <br />o give authorily to violate or cancel Ihe provision of any o�her stale or local law regulating construction or the performance of <br />:onstruclion. That 1 m aulhorized by the owner of ihis property to peAorm the work for which appiication is made and I comply with the <br />itale .oniraclors v� 1627�VV and 296200 WAC. <br />ii IIaWrPM(1���/r ���� ����� <br />L�� <br />