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PEaMIT APPLICATION - - <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETI', WA 982C1 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 1.f �-a.C� �G� <br /> S/ITE ADDRESS PARCEL TAX I.D.# P�EyRM- 'IT# <br /> l �� �� .S T 1 v �i �-� �d7 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �L�.S/�� S�N (J'-�- <br /> TENANTNAME CONTACTPORPERMIT PHONE <br /> r7i- � ///r�2�LJ i�/'� E•MAIL <br /> CONTRACTOR � n D RESS ITYIZ P E <br /> P�o,n� �.�u,��o,��f� iZ�o�i izt�-�'X ,rr ��,-<«�� Yzr-�rv_ <br /> CONTR.LICENSE# pv����p�Z-���, ti /p Z2� Yf�� <br /> / <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXi i1RE OR ITEM <br /> � Toilet _ A/C-air handling units <br /> Balhlub Forced air syslems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> � Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas ranc�e <br /> Clolhes washer Clolhes dryer <br /> Water heater Range hood <br /> � Sink(servicelbar/mop/etc.l _ Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> � Grease trap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and e±camined this applicalion and know the same to be true and correcl. All provisions of laws and <br /> ordinaces governing lhis type o(work will be complied wi�h whelher specified herein or nol.The granling of a permit does nol presume <br /> to give authorily to violale or cancel lhe provision of any olher stale or local law regulating construction or the performance of <br /> construction. Thal I am authorized by lhe owner o(lhis property lo perform the work for which applicalior is made and I comply wilh lhe <br /> Slate CoNraclorg La 18.2 W and 296.200 WAC. <br /> /y� �� � <br /> ' 1l/1�/'0 ' -�- y-2y= 0 `I <br /> SigvtatTife of OwnedConlractodAuthorized Agenl Date <br />