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�.-, :;�� j _ 'ERM11' APPLICAI �OIV <br /> : i CITY OF EVERETT PERMIT SERVI�ES <br /> � � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425�257-8810 — FAX 425-257-8857 <br />���"`° , <br /> ��rl ; SITE AUDRESS PARCEL TAX I.D. X PERMIT� <br /> �� ' ' ► � i� 3 d�`' ►11oa -o °� ' <br />' ,�.. � LEGA LOT N0. 6LOCK TRACT <br />� � �'� � �ESC. <br /> ';?_. <br />� � OWNER ADDRESS ZIP I�i!ONE <br />�i ` .�:,� , <br /> ,� '�, �aaiD �W�K�e) S,�',F�-, lY�I D� /�(�S+ A„e SE S�z�o (4�� 3�r3-s7r� ' <br />�^. �� TENANTNAME I CONTACTNAME PHONE <br /> �"*' �bh'�e cSM;i-�, lJ:, Ne cSr�;+4 (�I2s1 343-57�1 <br />�� • �. I CONTRACTQR • AOORESS ZIP CONTR.LICENSE q <br />. ��' �IU!-�C'Qe /NFL�tiiCA� � <br />�`#, ', PHON� Ll25 3�l? �j3�/�� <br />� ��� I <br /> 9y� '� . I PROPOSED USE OF OU�LOING In_.r� Building f1 Mechanical Addilion HEAT SOURCE <br />�['�l' .�q����� � PERMIT � ) Combinalion �� Plumbing WORK R A!temtion � Electric <br /> ��, � �I „ �_ n TYPE D Demolition U Sign IYPE D New Gas <br /> .� � , L� U Sprinkler U Repair/Maint. Other <br /> / <br /> P' �� "tS`i '' COPiTRACT PRICE OF WOflK �CyfO CITY OF EVEPETT LOCAL SALES TA%COOE IS 3105 <br />�� yy �(/ <br /> �.��'.�.�• �� ' WCP.KDESCRIPTION <br />�`,�" i <br /> �S <br />} Qgl <br /> C 'k' {� <br /> y�'`�.I <br /> "��� 'j PLUMBING MECHANICAL <br /> N. �`�; - N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />,� _ -: i <br /> `�`-�,.� _ WATER CLOSET _ A/C—A/HANDLING UNITS <br /> � - � BATHTUB pORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> SHCWER UNIT HEATERS <br /> KI?CHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY � WA�ER HFATEFi <br /> CLGTHES WASHER METAL FiREPLAf,E/STOVE <br /> URINAL FIREPLACE INSERT <br /> _ D�iINKING FOUNTAIN � GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICElBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I <br /> I I HEf1EBY CEFITIFY'HAT I HAVE READ AND EXAMINED THIS AFPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br /> PROVISIONS OF W WS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEfHtF SPECIFIEO HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ?HAT I PM AUTHORIZED BY THE <br /> OWPJEA OF THIS PROPERTY 70 PERFORM THE WORK FOR WHICH APPLICATION la MADE AND I COAIPLY WITH THE STATE <br /> CONTRACTO 5 LAW 18.27 RGW AND 296.200 WAC. <br /> � �/ �i�1�� � (I/l8/o2 <br /> i na u ol O� er/Contraclo� uthorized Agent Date <br /> � <br />