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SITE ADDRESS <br />LOT NO. <br />ERMIT �4PPLICATrUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />� <br />BLOCK , TRACT <br />PARCEL T.4X I.D.11 <br />�I co-7 3— � D 3 <br />— po7- o0 <br />rtl <br />PERMIT # <br />C�3 <br />y {' 12 <br />��r��+a G 55�/ d519 1�1k.1n�� Si, 9�� tias-asa=i�is <br />TENANT NAME CONTACT FOR PERMIT PNONE <br />�mMc, Ci�sSr� {Mik� ��sa.n `115- 3a7-a53S <br />CONTRACTOR AODRESS ZIP CONTR. LICENSE t <br />l.c,rse,� Co�st 310 I���erSo., 3��d E,���ff qVamr LARSEc � � ol D H <br />PHONE <br />PROPOSED USE OF BUILDING <br />RtS,a�,�l+..� <br />CONTRAC'1' PRICE OF WORK <br />�r Building Mechanical <br />PERMIT [} Combination � Plumbing <br />TYPE D Demalition Sign <br />u Sprinkler <br />�o�$5a� r <br />WORKDESCRIPTION (1�;r ����dai1M / new <br />-�n0rinc� _ Pk�wt Iti}'tri.T^ <br />NO. I TYPE OF FIXTURE OR ITE.V. <br />1 WATER CLOSET (TOILE.T` <br />� BATHTUB <br />� LAVATORY (WASH BAS�N) <br />SHOWER <br />� KITCHEN S�NK 8 DISPOSAL <br />L'ISHWASHER <br />� U.UNDRY TRAY <br />J_ C� �)THES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPIETC.) <br />= OTHER <br />�Addition HEATSOURCE <br />Alteratlan � Eleclric <br />New Gas <br />RepairlMaint. ONer <br />CITY OF EVERETT LOCAL SALES TAX CODE IS :itCS <br />ki��,�+c.� � Qa��� r[ioLiG An�l ne.J v��y� <br />% <br />NO.. I 1'/FE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES ORYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHErR i i. � �'��[nt <br />-h! Q�f[�IL[{. <br />I HEREBY CERITIFV THAT I HAVE READ AND EXAM17INED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHET4ER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TNE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF COhSTRUCTION. TF1AT I AM AUTHORI2ED BY THE <br />OWNER OF 1'HIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1027 RCN' AND 296200 WAO; �, <br />