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PERMIi' �4PPLICATION <br />CI�Y OF EVERETT PERMIT SERVICES <br />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 - DEBIT & CREDIT CARUS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�i��\\ `�1'� 1\v� �'c E�[e.�-2tt `�� <br />LEGAL LOTNO. BLOCK <br />DESC. ���� pGr � <br />OWNER <br />\\\G�.c'tiK- L. �ln.S�..2� <br />TENANTNAME <br />PARCEL TAX I.D. # <br />I � 40� <br />TRACT <br />Gc.� c�,<\e_. <br />CONTACT FOR PERMIT <br />> S\V'`�5��� <br />PHONE <br />� �..,� �ti5 �,1��v� ��� 4a5 ��<a-"�oa3 <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />(�c\��\� Fa,-.�,1.��l�c��.�,� <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink &disposat' <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Pountain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Other <br />HEAT SOURCE C�NTRACT PRICE OF WORK <br />Electric �Gas Other <br />NO. I NPE OF FIXNRE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gasrange <br />lothes dryer <br />R ge hood <br />Exh stfan . <br />Heal �mp <br />Und heat�r <br />Boiler \ <br />Other <br />CI7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify thal I have read and examined this appliraiion and know the same to be true and correct All provisions of laws and <br />ordinaces governing this type of .vork will be complied with whether specified herein or not. The granting of a permit dces not presume <br />to give authority to violate or cancel ihe provision of any olher s�ale or local law regulaling consWclion or the performance of <br />conslruction. That I am authorized by lhe owner of this property to peAorm the work for which application is made and I comply with the <br />Stale Contractors Law 1827 RCW and 296200 WAC. <br />i6,r��_,��� �'�.S-c=a <br />