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S E ADDRESS <br />� ��� � <br />LEGA l0T N0. <br />C��� 1 I �L <br />TENANTNAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www,evereltwa.org <br />APPLICATiONS ARE ACCEPTED FR01.1 8 AM TO 4 PM <br />BLOCK <br />�OG��S <br />PARCEL TAX I.D. N <br />TRACT OR SUBDIVISION p <br />CONTACi FOR PERMIT <br />PHONE <br />NTRA,. R A R E�MAIL <br />CONTR. LICENSE p <br />� L(i /�--�•'L1. <br />USE OF BUILDING <br />WORK DESCRIPTION <br />� ti_'� r� ��R <br />� �� �> <br />NO� I TYPE OF FIXTUI2E OR ITEM <br />—i <br />� o���� <br />Dathtub <br />_ Lavalory (wash basin) <br />Shower <br />_ Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />_ Sink (service/badmop/elc ) <br />Backllow prevenler <br />Urinal <br />_ Drinkinc� Fountain <br />Floor drain <br />_ Grease Uap <br />_ Rool drains <br />Othcr <br />HEATSOURCE <br />_ [leclric _ Gas _ Other <br />�/ G� �� <br />1 <br />,�v� ��� �, <br />PERMIT # <br />�C7� 10 -u-l� <br />CONTRACT PRICE OF WORK <br />NU. I TYpE OF FIXTURE OR ITEM <br />NC — air handling unils <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas firepiace <br />Gasrango <br />Cblhes dryer <br />Rangehood <br />Exhaustfan <br />Heal pump <br />Unit hoater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br />I hereby ceritily Ihat I have read and examined this application and know ihe same to be irue and wrrecL A�I provisions of laws and <br />ordinaces c�oveming Ihis type of work will be complied with whelher specified herein or noL The grantinc� of a permil does not presume <br />lo yive aulhority to violale or cancel lhe nrovision ol any ether slale or local law regulating conslruction or the peAormanoe of <br />conslrudion. That I am authorized by the owner of Ihis property to pertorm lhe work (or which applicalion is made and I comply wi�h the <br />Slalc Confractors Law 1�7 RCW and 296.200 WAC. <br />� � i <br />_ �' �����-- - i0- ��-> C�R <br />