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FERMIT APPLICATION <br />C1TY OF EVERETT PERf�AiT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />4 _0-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADORESS PARCEL TAX I.D. # r nmi i�� <br />hbl'S ��'�f���/1� i,f�� -��. <br />LEGA LO7 N0. BLOCK TRACT OR SUBDIVISION # <br />�ESC. <br />OWNER AD�RESS GTY/ZIP PHONE y`7.}y� ' <br />�✓ilik,tl (n/iLTSH/� (l/ii�� �aCKC-:FE[(f� Ect'f-�T �j.o �_v, 3E.S'S <br />TENANTNAME <br />CONTACT FOR PERMIT <br />PHONE <br />I E-MAIL <br />NTFiA TUR � E � E <br />CONTR. LICENSE N �(�1,�� � <br />USE OF BUILDING <br />HEAT SOURCE <br />E�edric Gas Other <br />CONTRACT PRICE OF WOAK <br />WORK DESCRIPTION (/j �(J (fE� �' /�J/tJ � FI�CJM �L E� I � Il T �� «� l <br />N0. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />L2eatory (wash basin) <br />Shower <br />Kitchon sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (serviceibar/moaetc.) <br />Backllow proventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />N0. I TYPE OF FIXTURE OR ITEM <br />NC — air handling units <br />/_�.; Forced air systems <br />� r� Gas pipir.9 <br />� a: Watorhealer <br />Gas Iireplace <br />Gas ranye <br />Clothes dryer <br />Range hood <br />Exhaust�an <br />_ Heat pump <br />Uni; haater <br />Boiler <br />Retrigeration <br />W oodstove <br />CITY OF EVERETT LOCAL SALES TA% COOE IS 3105 <br />I t•ereby ceritily that 1 have read and examined this application and kno�v ihe same to be irue and correcL Atl provisions of :aws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The gran;ing of a permi? does not presume <br />;o give authority to violalo or cancel the provi>ion ol any other state or local law regulating construction or the pedonnance ot <br />constmction. That I am authorized by the owner of this property lo pertorm the work lor which application is msde and I comply with the <br />Stoto Conlractors Law 78.27 RCW ard 296.� WAC. <br />f � ,,. <br />-;%',. .>�_' -�---___. `i/ � �;-� <br />