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PE. �MIT APPLICATIO��. <br />CITY OF EVERETT PERMIT 3ERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 - FAX 425•257-8857 <br />SITE ADDRESS <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />TENANTNAME <br />CON?RACTOR <br />PHONE <br />PROPOSED USE OF BUILDIN� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />� NO. � TYPE OF FIXTURE OR REM <br />PARCEL TAX I.D. F <br />BLOCK TRACT <br />ADDRESS <br />ICONTACTNAME <br />ADORE55 <br />WATER CLOSET <br />BATHTUB <br />i _ LAVATORY (WASH BASIN) <br />SHOWER <br />KITCIIEN SINK & DISPOSAL <br />DISHWASHER <br />� LAUNDRY TRAY <br />_ CLOTHES WASHER <br />� URINAL <br />I DRINKING POUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK �SEPVICE/BAR/MOP/ETC.) <br />PERMIT <br />nae <br />j� Bullding <br />� S Combinatlon <br />� � Demolilion <br />D Sprinklar <br />n Mechanicel <br />�-"} Plumbing <br />D Sign <br />PERMIT N <br />PHONE <br />tIP CONTR. LICENSE M <br />Atldilion MEAT SOURCE <br />Alteraliun Q Eleciric <br />New �] Gas <br />RapalUMeint. �� olner <br />CITY OF EVERETT LOCi\l. SALES TAX CODE IS 3f 05 <br />MECHANICAL <br />N0. � TYPE OF FI%TURE OR ITEM <br />A/l; – A/HANOLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATEiiS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />OAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />i I HEREBY CERI1lFY THAT I HAVE READ ANO EX4MINED THIS APPLICATIOM AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />� PROVISIONS OF iAWS AND ORIDINACES GOVERNING THIS TVPE OF WqfiK WILL BE COMPLIED WITH WHEfHER SPEGFIED HEREIN OR <br />� NOT. THE GRANTING OF A PERMI7 i�OES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PFOVISION OF ANV OTHER <br />STATE OF IOCAI. L4W REGULATING CONSTRUCTION OR THE PERFURMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORI.1 THE WORK FOR WHIC��� •1PPUCATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS U1W �6.27 RCW AND 296.200 WAC. <br />Signalure o wneuConuactor/ u�honzed Agent a�— <br />