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./� <br />� <br />��-/�`la e - ,/d�,e <br />L rr'� �N .r� <br />P� U�-�I. � P�rS�h tiH✓��Y �-r.D�" <br />r <br />c <br />r�'M� n� � k �'�� ni.i e= I <br />k%� �o.�Q ,. oF . ,.r,vi <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX A25-257-8857 —www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />LOT NO. <br />TENANTNAME �/'� C <br />c U <br />n} <br />CONTR. UCENSE M <br />TAX I.D. A <br />TRACT OR SUBDIVISION N <br />2�11� �'-'oo�:i S'T <br />ICONTACTFORPERMIT <br />��ol� L�aIS,J��� <br />�'J �oi� o�i <br />USE OF BUILDING <br />'�O �3oK 1 tD <br />HEATSOURCE <br />_ Gas _ Olher <br />C <br />I�l'����� ,� (1� �� <br />���`, i��Fv� <br />��� �r� <br />_ a- a '-1 D <br />� <br />�2�C+.� .`���Z �Zti ;rvj3—i%L <br />PHONE <br />E-MAIL <br />>V:1\c <br />I� <br />z5 - 3i�"v' —06?J <br />� 1 ��(�.�{ e•{'��te✓e�{ � ran� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPT�ON " <br />%�s-1a.\l moc�ar- F.��.1�,n Per Mo.�,.�-1��(-i.ces ��eec-Cz ea.�=,ons <br />eD�lnC'G-E' 6Ru.�tc�a- lJt�-iir S¢.I v�« -Eo bk;\dtR� ( <br />NO. I TYPEOFFI%TUREORITEM <br />Toilet <br />Bathtub <br />Lavalory (�vash basin) <br />Shower <br />Kitchen sink 6 disposal <br />Dishwasher <br />Clolhes �•+asher <br />Water heoter <br />Sink (service/barhnop/etc.) <br />DackOow preventer <br />Urinal <br />Drin4ing Founlain <br />Floor drain <br />Gmase Irap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air hand'ing unils <br />_ Forced air systems <br />_ Gas pipin� <br />_ l^Jater heater <br />_ Gas'�replace <br />_ Gas ranye <br />__� Clothesd�yer <br />Ranpehood <br />Exhaust fan <br />Heat pump <br />Unit heatcr <br />Bailer <br />Refrigeration <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />. l�" <br />�Q�u <br />I hereby certify that I have read and examined this appllcalion and knmv the same to be lrue and correct All provisions of laws and <br />ordinances governing this rype of work will be complicd �»Ih whetlier specif ed herein or not. The granting of a pennit does nol presume <br />to c�ive aulhonty to viola�e or tancel Ih= provision of any olher stale or local law rec�uiating conslruction or Ihe perfortnance of <br />constructi atl2rm aulhorized by Ihe owner of this property lo pedomi ihe work for which apptication is made and I comply wi(h the <br />S�ale Cm ac,t s�ay� �8.27 RCW and 29620� WAC. <br />'lL <br />