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��RMIT APPLlCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-?810—FAX 425-257-8857—www.everettwa.org <br /> APPIICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM ��� � _ U�/ <br /> SITE ADDRESS PARCEL TAX I.D.A PERMIT It _i1' � <br /> / Me��;� A�c no(o I � � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> i <br /> G/�ii 2er.7 .S//A�J �Sar'/e. C7 <br /> TENANTNAME ( CONTACTFORPERMIT PHONE <br /> i -i26.J "/�� .l ��`y <br /> CONTRACT l' ADDRESS CITY2IP PHONE <br /> -���J '��' �? y�s �ry ��3� <br /> CONTR.L � — Gi <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> s`� �Electric Gas Olher � ?' ' '_ � <br /> WORK DESCRIPTION <br /> �L',5'�i1G �.5� �//�C �1��'��G <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE QF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> � Bathtub � Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower �, Waterheater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer � Clothes dryer <br /> - Water heater Range hood <br /> i Sink(servicelbadmop/elc.) _J__ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ lNoodslove <br /> Roof drains Other <br /> Olher <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and ezamined Ihis appli%,ation and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces governing lhis typo o(work will be complied with whefher specified herein or nol.The granling of a permil does nol presume <br /> to give authorily lo violate or cancei the provision ot any other stale or local law regulating construction or the performance of <br /> construction.That I am authorized by Ihe owner of this property to periorm lhe work tor which applicalion is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> -� �l� 7 <br /> �-z �,� r�i� -��- <br /> 6ign�vre of OwnedContractodAul ionzed Agent Date <br />