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PEf�MIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />�25-257-8810 — FAX 425-257•8857 <br />SITE ADCRE39 <br />.�i I q�'� �. <br />LEOA L�r N0. <br />oesc � P�n a�1 0� � <br />OWNER <br />leu��es <br />TENANT NAME <br />CONTRACTOR <br />6R�� C^�• /�� <br />PHONE <br />PROPOSED USE OP BUILOINd <br />Sn�� �n���y � • <br />CUKTRACT PRICE OF WORK <br />WO KDE9CRIPTION '!_7"� <br />�t�d AutlSc= P C <br />I77 <br />�T <br />BLOCK <br />NO. I TYP[ OF F'.(TURE OR ITEM <br />PARCEL TAX I.D. � <br />� a3-7S7-Oo�—oo3-02- <br />T CT <br />�RcR4�9 C�.-^v�'s b�a��a�n F <br />ADDREbB �P <br />� 6 ,�xx, 3oa� �JT 9�3 <br />CONTACTNAME <br />ADORE58 �P <br />Pa, �,� 3ms— ���', q�3 <br />Buildlnp D Mechenical <br />PERMI7 � Combinelion �] Plumbinp <br />TYPE Demolitlon U Sign <br />Sprinkler <br />M <br />r� • ., <br />PMONE <br />CONTR. UCENSE � <br />6�tc�o99mC <br />f'� AdAlllon <br />I--( Alterotbn <br />���� New <br />6 RepelrR.lalnl. <br />NEATSOUHGe <br />�ElecVlc <br />Oee <br />Olher <br />CfTY OF EVERETT LOCAL 8ALE8 TAX COOE :S �ID6 <br />A , � �{00 Tj� ��x,� . ' <br />� WATER CLOSE7 <br />L BATHTUB <br />� LAVATORY (WASH BASIN) <br />_ SHOWER <br />� KITCHEN SINK 8 DISPOSAL <br />_[_ DISHWASHER <br />LAUNDRYTRAY <br />J_ CLOTHES WASHER <br />_ URINAL <br />DRINKIMO FOUNT.iIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEIBAR/MOP/ETC.) <br />OTHER <br />��L � �¢-OD <br />N0. I TYPE OF Fl%TURE OR ITEM' <br />AIC — AIHANDLINO UNITS <br />FORCED AI!9 SYSTEMS . <br />HEAT PUMP � <br />UNIT HEATGRS <br />CLOTHES DRYER <br />RANOEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />OA5 FIREPLACE <br />OAS RANOE <br />OAS PIPINQ <br />EXHAU&T FAN <br />OTHER <br />I HEREBY CEF;ITIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. A.'. <br />PROVISIONS OF LAWS AND ORIDINACES QOVERNINO THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN O� <br />NOT. THE 6RANTIN6 OF A PEFMIT �OES NOT PFESUME TO OIVE AU7HOfi11Y TO VIOUTE OR CANCEI THE PROVISION OF ANY OTMER <br />STATE OR LOCAL LAW f7EGUlATINO CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONSAACTORSLAW 18.27 RCW AND 288.200 WAC. <br />/ <br />YZ <br />