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PL'��MIT APPL�CATI4��J <br />CITY OF EVERETT PERMI'f SERVICES <br />3200 CEDAR STREET, EVERCT7, WA 98201 <br />425-257-8810 - FAX 425-257-SP57 <br />SITE ADDRESS <br />si � ��� d�,/ <br />LOT NO. � I'��LOCK <br />.�-1 - 0 / <br />TENANTNAME <br />PARCEL TAX I.D. # <br />iD S `� r' C�G <br />TRACT <br />� 3 P G CS /- <br />nooaess <br />� u Io,Y�'�� .� <br />CON— T�NAME � <br />, �� c '/� / '"�- <br />CONTRACTOR S�_`�17� ADDRESS <br />�,�e.�le-r/ <br />�� �-P ��iY c:-.T T c . <br />PHONE <br />PROPOSED USE OF BUILDING <br />C P �� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION ;f-��ja� <br />/G� <br />s�zt-� <br />(�l Building Mechanicai <br />PERMIT ��Com6ination R Plumbing <br />TYPE Demolilion p Sign <br />B Sprinkler <br />�G� i � �3� i3 <br />NO. � TYPE OF FI%TURE OR ITEM <br />WATER CLOSET ( /� <br />BATHTUB! <br />LAVATORY (WASH BASIN) I1 I <br />SHOWER �� <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASH[R <br />URINAL <br />DHINKING FOUPITAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PERMIT # <br />o� co�D <br />- O/� <br />� rd 9-/o v��. r, t. <br />� ��.-P �, �ti,�. �� ��p, <br />PHONE <br />u `/�S �? Z <br />21P CONTR. LICENSE M <br />(„/ e•itlOe sa 995�`I c - <br />Addition <br />WORK Alleration <br />T'PE ew <br />Repair/hlaint. I <br />HEATSOURCE <br />n Electric <br />f1�=?-,r_as <br />LJ Other <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />N0. 1 TYPE OF FIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAI. FIREPLACE/STOVE <br />FIREPL4CE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN 1��/ <br />OTHER <br />I NEFEB'f CERITIFY'HAT I HAVE READ AND EXAM�NED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF WWS ANO ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED tiEREIN OR <br />NOT. THE GRANTIN6 OF A PER�+f1T DOES NOT PRESUAtE TO GIVE AUTHORITY TO VIOI.ATE OR CANCEL THE PFOVISION OF ANY OTHER <br />STATE OR LOC�L LAW REGULITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOP'v1 THE WORK FOR WHICH APFLICATION IS h1ADE AND I COMPLY WITH THE STATE <br />CON7RACTORS lAW 18.27 RCW AND 296200 WAC. <br />�/y/� <br />ya. <br />