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01,'ll/:SO10 1'_':1� I':\S <br />SITE ADORESS <br />\ � � <br />LE 1.0T NO. <br />OESC. <br />OWNER <br />�io c� � 3f2 s�t�c <br />TENANT NAAAE <br />1 AG - 'e <br />CONiR. IICE E Y �, <br />USE OF BUILDING <br />WORK DESCRIPTION <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVlCES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 42r257-8857 - �vww.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� •. <br />Np, � TYPE OF FIXTURE OR I7EM <br />Toilel <br />BalhWb <br />Lavatory (wash basin) <br />Showcr <br />Kilchen sink & disposal <br />Dishwashcr <br />Clothes washer <br />Water hoater <br />Sink (serviceJbarlmop/etc; <br />Ba�cflow preventer <br />� Urinal <br />J Drirking fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other _ <br />PARCEL TAX I.D. p <br />TRACT OR SUBDNISION f� <br />FOR PERMIT <br />PHONE <br />I(Ji. 000°/U003 <br />PERMIT i1 <br />'VI I �61 - o; C�� <br />�� =� (1C. b1�o ? 2-1 �;� �84� <br />�, � <br />f�Y�-k" � �, �c; U <br />HEATSOURCE <br />_ Eicdric ,� Gas _ Other <br />GONTRACT PRICE OFWORK <br />NO. I 7YPE 6F FIxTURE DR ITEM <br />AIC — atr handling u�ils <br />Forced air systems <br />Gas pipin� <br />Water healer <br />Gas firepiace <br />Gasrangc <br />Clothes dryer <br />Range hood <br />Eziiaust fan <br />Hcal pump <br />Unit heater <br />Baler <br />RefrigeraGon <br />Woodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS J1U5 <br />I hereby cert�fy that 1 have read and examined lhis appli;ation and know the same to be Irue and coved. A11 proviswns ot Iaws and <br />ordinances gaveming this type of work vnll be com0��� �ih WheNer speci6ed herein or not. The granting of a{mrmit does not Cmsume <br />to gNe authonty to violate or canc..M the provision et any other state or bnl Iaw regu�aEng consWctio+� or the pedormance of <br />wnstrudion. That I am author¢ed by the owner ol this propetty lo peAorm ihe weAc for which application is made and I compN witti lhe <br />Slate Contr �ors Law 78.27 RCbN and 2°6200 WAC. <br />i1 , ��n..���'ln��: )l;iii;�. <br />