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�CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 / a`// <br />425-257•A85i FAX <br />530 MUROAN ItU, GY6RE'I'I', N'A 'IS'-03 I UU3y33UW09GUU <br />IEGAI LOT NO. BLOCK <br />DF$G. .. <br />OWNER AD�RESS <br />F'O DO\ 2717 <br />SM1711, M,iD1iLIN[ <br />• t\!IiKGI"1'. WA 9A213 <br />TENANTNAME CONTACTNAME <br />PGRMITTb1lI1.1.IN�::•IA7INAM C�rolRandall <br />CONTRACTOR IADDRESS <br />PAST WATLR HEATER COMPANI' 12G0] 132ND AVL �L• <br />1:1ftKLAVD, WA 98034 <br />425-63G-70r1 <br />PROPOSED USE OF BUILDING sw�ainp M�cnanic WOR� <br />PERA!li Combbudon ' Plu�mhlnp TMPE <br />Resldrnlial 7ypE ��molitlon 81 n <br />CONTRACT PRICE OF YJORK j347.M1 , CITY OI' EYERE <br />WORK OESCRIPTION �tcmmr/Iicpincc I?Icccric \Ymcr Ilcatcr <br />LAVATORY (WASH UASIN) <br />SHOWER <br />K�TCHEN SiNK 6 DISPOSAL <br />DISHWASHER <br />LAUNORYTRAY <br />CLOTHES WASHER <br />URINAI. <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEI'3ARIMOP/ETC.� <br />OTMER <br />� <br />2�0 <br />PHONE <br />(q25)35G-26J2 <br />FAS'fN'\1'H9-0BBC <br />oirouzotn <br />PORCED AIR SY3TEM3 <br />MEAT PUMP <br />UNIT HEATERS <br />GLOTHES Dt1YER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACFJSTOVE <br />FIREPLACE �NSERT <br />GAS FIREPLACE <br />GAS RAN6E <br />GAS PIPiNG <br />EXHAUST FAN <br />I HEREdI' CERTIFY THAT I HAVE READ AND EXAMINEO THIS APIICATION ANO HNOW THE SAAIE TO 6E TRUE ANO CORRECL ALl <br />PROVISIORS OF 1r1Y1S ANU UROINANCES GOVER4ING THIS NPF OF �VORK �NILL BE COM?LIEO \YIHT 1NHETNER SPECIFIED HERE <br />OR NOT. 1HE GHANTNG OF A PERMIT DOES NOT PRESUME TO CNE AU7HORIiV TO NO:.l�TE OR CANCEL THE PRONSION OF AYY <br />OTMER STATE OR LOCAL IAVi REGULATING CUNSTRUCTInN OR TME �ERFORMANGE Or CONSTRUCTION. THAT 1 hMAUT1iOR�ZE� <br />81' THE 01VNER OF iH15 PROPERTY TO P[RFORM THE WORH FOR Y�NICH PPPLICAT0.Y ISlA4CE AN01 COMPI.V 1'IRH TME STATE <br />C04TRACTORS LAW 18.27 RCW AND 2B6 =00 WAC. <br />nalure of OwnudContractorlAulhorizod Agent Ly�,�;{I� (� �,,,IcEF' Oata 12�� �i�p09 <br />CI!:1 <br />T <br />� <br />0 <br />3 <br />N <br />� <br />� <br />N <br />0 <br />0 <br />[n <br />A <br />� <br />0 <br />sz <br />� <br />ID <br />CJI <br />� <br />O <br />N <br />O <br />O <br />N <br />