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SITE ADDRESS <br />�i:ZO L 7h <br />LEGAL LOT NO. <br />UESC. f <br />TENANT NAME <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />PtRMIT APPLICATIUN <br />CITY 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 <br />PARCEL TAX I.D. # <br />BLOCK � TRACT OR SUBDIVISION # <br />� <br />V� <br />� G� L���ccJ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clalhes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Z Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Olher <br />' l� �h �'T � <br />ICONTACT FOR PERMIT <br />C �iUURCJJ `/-I � I v <br />r <br />✓ <br />S� s2s� G � s <br />� <br />PHONE <br />E•MAIL <br />� _� g-o� <br />PERMIT # <br />C�4,o"l'01� <br />10NE <br />.� ( �/1S/7o'r_f'ucr. <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Eleclric Gas Olher <br />NO. � TYPE OF FIXTURE OR ITEM <br />k'C — air handlin� unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unil heater <br />Boiler <br />Refrigeralion <br />Woodslove <br />Olher <br />CITY OF EVERETf LUCAL SALES TAX CODE IS ??05 <br />I hereby cerili(y ihal I have read and examined this application and know the same to be irre and correct. All provisions o( laws znd <br />ordinaces governinc7 this lype of �vork will be complied with �vhether speci(ied herein or noL The granling of a permit does not presume <br />to give authority to viulate or cancel the provision of any other slate or local law regulating construction or the performance of <br />conslruction. That I am authorized by lhe owner o( lhis properfy to peAorm Ihe work for which zpplication is made and I comply wilh the <br />Slale Contracfors Latv 18.27 RCW 2nd 296200 WAC. <br />- z�-_ <br />