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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 �(,J �j' OS" <br />SITE ADDR�SS <br />�).�� �- ��r �:, s. �. <br />LOT NO. ^ I BLOCK <br />,ri <br />TRACT <br />PARCF.L TAX I.D. A <br />�� ns�t� <br />H� 2�: / G /-�.,,�• <br />PERMIT N <br />����;-�,i <br />�.t�Qn.c%�f/ S< o f� ,Ov.c•� h�. <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />.SAt"�(� I ,�c%� ii /�cr,A.i/ o '�� �. 3�. -f �.� <br />CONTRACTOR ����p ADDRESS CITY2IP PHONE <br />CONTR. LICENSE 0 . � <br />USE OF BUIL�ING <br />.r� i/ <br />WORK DEuCRIPTION ,J � 3� � � <br />� � �� � <br />NO. I TYPE Of FIXTURE OR ITEM <br />Toilel <br />Balhtub <br />Lavalory (wash basin) <br />Showcr <br />Kilchen sink 8 dispusal <br />Dishwasher <br />Clothos washer <br />Wator hoalor <br />Sink (sarvlcc/bar/mopletc.) <br />Backllow prevontor <br />Urinnl <br />Drinking Fauntafn <br />Floor draln <br />Greasolrap <br />Rool drains <br />Olher <br />HEATSOURCE <br />_Electric �—�as <br />O�her <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FI%TUPE OR ITEM <br />A/C - alr handling unils <br />ForceC a�r syslems <br />Gas piping <br />Waler hoalor <br />Gac fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Ezhausl(an <br />Hoat pump <br />Unil heater <br />Boller <br />Rolrigeration <br />Woodstove <br />� <br />CITY OF EVERETT LOCAL SALES TA7( CODE IS 3105 <br />I hereby cerilify ihal I havo read and oxamined this applicalion and know the samo to Fe true and correcl. All provislons oi lawe and <br />ordinacUs govorning Ihis lypa ol work will bo complied with whethor specilied horein or nol. The grenting ol a permit does nol presume <br />to giva aulhority to violato or cancel the provislon of any other state or local law regulating conslruction or Ihe performance of <br />conslruction. Thal I am aulhorized by tho owner of Ihis property to peAorm Ihe work lor which appllcalion Is � iarle and I comply with lhe <br />Stato Contradors Law 18.27 RCW and 29�.200 WAC. <br />sGJ /�d ° S 1 h <br />