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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICE; <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425.257-8851 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />SI ADDRESS �JL L �,E --- PARCELT ip PF�td/)�, <br />LJ / L <br />I n T JBLOCK <br />o Cann <br />LEGAL LOT N0. TRACT Oil SUBDIVISION p <br />UESC, 61- �/_ 44 <br />O NER ADDRESS CITY/ZIP PHONE q'— <br />' , lga9 1 C --clef 1� I <br />TENME CONTACT FOR PERMIT PHONE <br />�[ 5 7 Z <br />�2 - L� ore EMAIL <br />i`TYYZiP -�i{aAE <br />V AUDRESS <br />LICENSE <br />-CONTR. <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />I <br />Electric _ Gas _ Other <br />- <br />WORK DESCRIPTION <br />ob <br />0 C <br />_ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units <br />Balhtub <br />Forced air systems <br />T <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />= <br />Water heater <br />Range hood <br />_ <br />Sink (servizelbar/mop/etc.) <br />Exhaust fan <br />_ <br />Backgow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Floor drain <br />Boller <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authorii!y to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br />am authSrWi lby the owner of this property perfprm the wgrk for which application Is made and I comply with the <br />constmction:'M20 <br />Slate ntrgctbrs Law 162 A,C d 296.200 WAC. / / <br />n u f Owner onl aclorlAuthorized Agent atov <br />