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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />11 3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL AX I.�. # PERMIT # <br />SITE ADDRESS <br />Ir�� / 762 goy a3o01 3E�9oyo�' <br />LEGA LOT NO. RL.00K /TRACT OR SUBDIVISION # <br />DESC. li k11VWz-e1 CO/ <br />OWNER ADDRESS CITY2IP PHONE <br />G �fd It✓Fjfjy�&n /UL'i>�7w'N�f LLL1 fly =2`� <br />TENANT NAME CONTACT FOR PERMIT PHONE WK 15r J„`�. <br />�I9rvn�/ti��cict� E-MAILciLiialt��ll�s rilx:I <br />G CONTR. LICENSE # = l�/,�, <br />USE OF BUILDING <br />41 <br />WORK DESCRIPTION <br />Ale <br />NO. I TYPE OF FIXTURE OR ITEM <br />3L <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Jr <br />Kitchen sink & disposal <br />Disnwacher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />_ <br />Backtlow preventer <br />Urinal <br />_ <br />_ <br />Drinking Fountain <br />Floor drain <br />_ <br />_ <br />Grease trap <br />Roof drains <br />_ <br />Other <br />HEAT SOURCE <br />Electric A_ Gas _ Other <br />CONTRACT PRICE OI• wunn <br />r /'�S Oeo <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />1 <br />Forced air systems <br />,f <br />Gas piping <br />J <br />Water heater <br />Z <br />Gas fireplace <br />Z <br />Gas range <br />_L <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pL np <br />Unit hc0er <br />Boiler <br />Refriger Lion <br />Woodstove <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give 4jAhority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />cons t ct vn. That I am aUrt,oted by the owner-ct tW property to perform the work for which application is made and I comply with the <br />r„6rrmmnrc I nw Xi.'Ap(A/ and 296.200 0C. , <br />l� <br />