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51TE ADDRESS <br />�101 ►-f�`Avt <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />f�aac.�C �3rdFhefs � <br />TENANT NAh7E <br />P�.RMIT APPLICATI�N <br />CIT'� OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98?01 <br />425457-8810 - FAX 425-257-8857 <br />BLOCK <br />CONTRACTOH <br />1-lo�cark gros, Ccr�s+mchZn <br />PHONE <br />�iLS-39i-�3 bo <br />PROPOSEO USE OF BUILDING <br />�f �EX <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />New <br />PARCEL TAX I.O. # <br />00 3923 000o io 10 <br />6 (���er�y C�G�'cievl <br />3922 B��hA� ,vr �vere++ `j�r5 y2s-s�'i7-73��0 <br />l. V rv 1 A{: I IVAME <br />PHONE <br />I Sc�l �}c�c�c [� �-12S-Z90 - 2. �i z-9 <br />ADDRESS ZIP CONTR. LICEN£E M <br />3�Z.Z S�7L�f}t,EN� ��e�c�- �as <br />Hs�ncua�o �a oz <br />Building <br />PEpM1T Combinalion <br />TYPE Demolition <br />Sprinkler <br />8o uoo <br />Mechanicai <br />Plumbing <br />Sign <br />Addilion <br />Alteration <br />New <br />Repair/Maim. <br />HEATSOURCE <br />Electric <br />Ges <br />Other <br />� I CITY OF EVEREIT LOCAL SALES TAX CO�E IS 3105 <br />p�,�l�x �iG 2207 <br />NO. � TYPE OF FIXTURF. OR ITEM <br />�� wq � tN GLOSET <br />� BATHTUB <br />_('L LAVATORY (WASH BASIN) <br />SHO W ER <br />'� KITCHEN SINK 8 DISPOSAL <br />�_ DISHWASHER <br />LAUNDRYTRAY <br />� CLCTHES WASHER <br />_ JRINAL <br />DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR'MOP/ETC.) <br />_ OTHER <br />✓ <br />N0. I TYPE OF FU(TURE OR ITEM <br />nru — NNANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATEFiS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLAr,E <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />i <br />v <br />I MEREBY CERITIFY THAT I HAVE READ >ND EXAM�NED THIS APPLICATION AND KNOW THE SAME TO 8E TqUE AND CORRECT. ALL <br />PROVISIONS OF L1W5 AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPIIED WITH Wh�ETHEfi SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMI7 DOES NOT PRESUh1E TO GIVE AUTHOR�TY TO VIOLATE OR CANCEL TF1E PROVISION OF ANY OTHER <br />STATc JR LOCAL IAW REGULiTINC CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEFTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AN01 COMPLY WITH THE STATE <br />I CO RACTO�LAW 18.2� qCW AND 29r6,2001VAC. <br />`rl�d 2 <br />