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�2° �� sr. <br />SITE ADDRESS <br />(zee�.�J � �Ace � <br />LEG�L LOT N0. <br />or_sc. 7 02 r 7-3 <br />PERMIT APPLICA`�ION <br />:ITY OF EVERETT PERMIT :iERVICES <br />3200 CEDAR STREET, EVERETT, V�.4 98201 <br />420-257-8810 — FAX 425-257-8857 — www.evereitwa.org <br />APPLICATIONS ARE ACCEPTED FROP118 A'JI TO 4 PM <br />BLOCK <br />, n-o0 <br />N o V i�� �- i��v�z.aPrv� �.rr se.e <br />TENANTNAME <br />N�lk <br />CONTRACTOR �0 H� ���'�[M�/�� <br />CONTR. LICENSE # <br />� `�� —L,� <br />C 1 ��C�� �f.� <br />PARCEL TAX I.D. # PER T/#/ \,� <br />oos�3g-Doo-�7a�� rn3-�l i� � Dc�_ <br />TRA�T ,� <br />s,�c,��yc, A-crr� 3 <br />ADDRE55 cmrziP PHONE y2S�3s1-Io110 <br />�s��s �aNa �E s �� w�- �so3z <br />CONTACT FOR PERM T <br />(,t) q-� ve �r <br />AODRESS <br />PHONE <br />�{2S- (�S6-7Y35 <br />CINIZIP PHONE <br />USE OF BUILDING S;uS �e_ �,� �,1 HEF,T SOURCE CONTRACT PRICE OF WORK <br />� C:i� � <br />R.25ide���l (,�u�on;u(w.. ^[lectric I�Gas_Other ,j�'���(Y�• OU <br />WORK DESCRIPTION � � • <br />'(b �6N57�c� 1 SrNraLC -Fyl7nic�./ .j�P 17a«iti b L'OtJ�OMi N1�t� l.l�UiT <br />I„ <br />� <br />� <br />N0. I NPE OF FIXTURE OR ITEM <br />� Toilet <br />� Bathlub <br />� Lavatory (wash basin) <br />� Shower <br />� Kilchen �; �4 & disposal <br />� Dishwasher <br />� Clothes washer <br />� Laundry iray <br />� Sink(service/bar/mop/eta) <br />Backllow preventer <br />Urinal <br />Drinkin9 Fountain <br />Floor drain <br />Grease irap <br />�_ Roof drains <br />Other <br />N0. I NPE FF Aii(TURE OR ITEM <br />NC — air handling units <br />rorced air systems <br />Gas piping <br />Waler hea�er <br />Gas freplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil hea�er <br />Boiler <br />Refrigeration <br />Woodstove <br />CIN OF EVERETT LOCAL SALES TN( CODE IS J105 <br />I hereby ceritify that I have read and examined this application and know the same lo be true and correcf. All provisions of !aws and <br />ordinaces governing lhis type of work vnll be complied with whether spedfied herein or not The granling of a permit does nol presume <br />to give authonty to violate or cancel ihe provision of any other stale or local law regulating consirudion or the pertormance o( <br />constru� ion. That I am authorized by the okner of ihis property to periorm ihe work for which application is made and I compty with the <br />Stale Qpr�traclqrs,L�w 18.27 RCW ap�29fj200 WAC. <br />—��- <br />