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P�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> AFPLICATIONS ARE ACCEPTED FROM 8 A�� TO 4 PM ��_ Q �O� <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT p <br /> ��7.z Tn���R. �{� � I_ �22 _ �0 7/(-GU� <br /> LEGAL LOT NO. BLOCK TRACT OR 5UBUIVISION k <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONEk,2���_-77� <br /> �K,�-nk7AL 4�_� TsLmrt m, �v�'F� �ooq_�r2�`�rt�`t 5���('�' 2oF� <br /> TENANTNAME CON CTFORPERMIT PHONE <br /> N�i T E�MAIL <br /> R � <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SUURCE CONTRACT PRICE OF WORK <br /> �,��{aL ��j2�� �'fleclric _Gas_Other � C �� <br /> WORK DESCRIPTION <br /> ���e ��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. Tl'PE OF FIXTURE OR�TEM <br /> Toilet A/C—air handling units <br /> Batlilub Forced air syslems <br /> Lavatory(wash basir.) _ Gas piping <br /> = Shower ' _ Water heater / <br /> Kitchen sink 8 disposal _ Gas fireplaco <br /> Dishwasher _ Gas range <br /> Clothes washer Clothes dryer <br /> Wator healer � � _ Range hood <br /> Sink(service/badmop/elc.) __ Exhausl fan� <br /> _ Backllow prevepter _ Heal purt�p' <br /> Urinal _ Unit healer <br /> _ Drinking F6untain _ B9�e� <br /> Floor d�ain �f�efrigeration <br /> Grease Irap _ Woodstove <br /> _ F�6of drains _ Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br /> I hereby ceritily ihal I have read and examined Ihis application and know the same to be lrue and correcl All provisions of laws and <br /> ordinaces goveming this lype of�vork will be complied with whelher specified herein or nol l�he grenling of a permi�does nol presume <br /> lo give authority to violate or cancel the provision of any other stale or local law regulating consUuction or the perfortnance oi <br /> construclion. Thal I am aulhorizr,d by�he owner ol lhis property lo pedorm the work for which application i,made and 1 comp�y with the <br /> Slate Conlraclors Law iB.27 RC i 9G.200 WAC. <br /> ��o'k. � �� � �— <br /> Sign lure of OwnedConlr2clodA ho � d A n� Dale <br />