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SITE ADDRESS <br />ISI 7 "nJt. <br />LEGALI LOT NO. <br />PERMIT APPLICATION <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 <br />y�v <br />BLOCK <br />TRACT <br />PARCEL TAX I.D. N <br />ch PcI 1 <br />%J t` Ct,^ tr ►.L< 15J1 N L,]rj}L}'i f(.arPl."! W33 �' �,)39119i <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />J1-tt- H e c <br />Domes F+tsr% `i2.S-7wco-'.)ZCITYIZIP PHONE2s <br />ADDRESS <br />CONTRACTOR <br />1Jor4'Wt'j I�oAr)1� 3 �1��fu 7rLr+ Rx bow 5Y�s7 <br />CONTR. LICENSE a <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO, I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc. ) <br />Backfiow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />CONTRACT PRICE of WOKK <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ A/C — air handling units <br />_ Forced air systems <br />_ Gas piping <br />_ Water healer <br />_ Gas fireplace <br />_ Gas range <br />_ Clothes dryer <br />_ Range hood <br />_ Exhaust fan <br />_ Heat pump <br />_ Unit heater <br />_ Boiler <br />_ ReMgeration <br />_ Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be We 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 presurne <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 2 RCW and 296.200 WAC <br />/07 <br />