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SITE ADDRESS <br />T, ; <br />� '_- <br />L�iiAl LOT NO. <br />DESC. <br />F�fZMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-88�0 - FAX 425-257•8857 - wvuw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM a`a <br />i ', i <br />� BLOCK <br />PARCEL TAX I.D. p PERMIT N <br />CC7��a �I�- <br />TRACT OR SUBDIVISION fl <br />��,. c-��v b� J it—�S ��� �,� 1..��.�<<.i� t.�21 3Sj-71�i <br />TENANT NAME CONTACT FOR PERMIT PHONE ��, �� j� �, � S'-� � <br />�— ---�� I'' � •' V � �� E�AAI� l� ��'� � �� «.,JA .• <br />I�'f' Ii.'.-: M� � ��c��)o�.���� `��1�`��i i�L ��(ILi 1��' I�l�. �'j� l C�� <br />CONTR.UCENSEM <br />i r- . �, �-fi 7�1. �� '17� <br />USE OF BUILDING � � I HEAT SOURCE I CONTRACT PRICE OF WORK <br />WORK OESCRIPTION <br />('bi;i <br />� <br />_ f_li�slnc ,__ Gas _ Olh�r �� ,: (� � <br />� <br />, _ � :,_ �„ . , <br />PLUMBING <br />�, NO. I TVPE OF FIXiURE OR ITEM <br />_r _ <br />� Toilet <br />-� --- Dalhtub <br />! Lavatory Iw�sh b�isu�� <br />Shower <br />Kitr.hen sink 8 disposxl <br />Dlshwasher <br />Clollies washer <br />Walr,r healer <br />Sink (servicelbadmop/ela) <br />Back�lcw prmenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Rool drains <br />Olher <br />N0. � TVPE OF FIXTURE OR ITEM <br />_ A/C - eir hanAling units <br />_ Fmcnd �ir sysloms <br />__ Gas pipiny <br />W�ter h�atrr <br />_ Gas lireplar.e <br />Gasrange <br />� Clalhes dryer <br />_ Rangehood <br />Exliausl fan <br />_ Haat pump <br />Unit hcatcr <br />Boiler <br />Rofrigoration <br />Woodetove <br />_� Other_ <br />CITV OF EVERETT LOCAL SALE8 TA% COOE IS 7105 <br />I hereby cerilily ihel I heve read and azamined Ihrs applicalion and know the same to be Uur. and cor�ecl. All provisions ol laws and <br />ordinacos goveming this type o! work will be complied wilh whe�her spocified herein or nol. The gra�ting ol a permit does not presume <br />to give authority to violatr or cancel Ihe provision of any olher stalo or bcal law regulating conslructir.n or the peAormanr,e of <br />consUuclion. Thal I���qqq auihorizeA by Ihe owner ol Ihis property lo p�dorrr� lhe work far which eppllcation is mede end I comply wilh ihe <br />Slate Cunlr2y�oi5lawI1N27 RCW an�i 29n 200 W�C. <br />� � '1 1 ( ,, •1 a ,� � <br />SignaWro of OwnodConlraclodAulhonred A�ent Dale <br />-- - ' <br />