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SITE ADDRESS <br />�� �Z� <br />LEGA LOT NO. <br />TENANT NAME <br />CONTRACTOR <br />P��MIT APPLICATI�J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />�lGfd�1-�- <br />BLOCK TAACT <br />PHONE � r �,, ��� �' <br />PROPOSED USE OF BUILDING <br />PERMIT <br />TYPE <br />CONTRACT PHICE OF WORK <br />WORK DESCRIPTON <br />�� ;�f� � <br />� <br />� <br />TYPE OF Fl%TURE OR ITEM <br />WATER CIOSET <br />BATHTUB <br />LAVATORY (WASH BAS�N) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PARCEL TAX I.D. • <br />NAME <br />ADDRESS /'fFiD'7 <br />�oca.�� <br />n Building <br />�� 1 Combination <br />« Demolilion <br />D Sprinkler <br />PEFMR • <br />M2aS-a� }r <br />rnune 3 � <br />�'.s�f� Cu/�- <br />Pl10NE <br />ZIP CONTR. LICENSE 1 <br />�� <br />Mechanical AOCi�ion <br />Plumbing WORK Alteration <br />Sign TYPE Naw <br />RapairlMaint. <br />HEATSOURCE <br />Electric <br />Gas <br />omer <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 7105 <br />%� �� <br />�� C�� <br />NO. I TYPE OF FlXTURE OR ITEM <br />A/C — AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORYER <br />RANGEHOOD <br />WATER HEATER <br />METAI FIREPLACE/STOVE <br />FIREPUICE INSERT <br />6AS FIREPLACE <br />GAS RAN(3E <br />GAS PIPING <br />EXHAUSTFAN <br />OTHEH <br />,�i�'viG <br />I HEREBV CERITIF THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT. ALL <br />PROVISIONS OF WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTI G OF MIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PPOVISION OF ANY OTHER <br />STATE OR LOCAL EGU TINGL CQNSTF�UCTION ' E PERFURMANCE OF CON� UCTION. TMAT I AM AUP.i0Al2ED BY THE <br />OWNER OF THIS OPERTY T PER6CIRM �fiE WO FOR WHICH APPLICATIONJS MAOE AND I COMPLY WITH THE STATE <br />CONTRACTOR W �827 RC AN�298. 0 WAC. �/�� �11 <br />i ,/�1/,( dl�% � <br />