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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 />SITE ADDRESS i <br />PARCEL TAX I.D. # <br />PERMIT # <br />LEGAL LOT NO. <br />DESC. 4( <br />BLOCK <br />TRACT <br />1 k.y25 D -c:c �'l. r wcE <br />uc <br />OWNER ADDRESS CITY/ZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br /><:-'�;> `Aj �t <br />4,.e o vi ; A-e s STy = s <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # 0 V,cr <br />USE OF BUILDING s`106L6 (AMIOY <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />> l � � I) L C- <br />_ Electric Gas _ Other <br />32600 <br />WORK DESCRIPTION <br />✓� 7-- A r,f <br />k � Se :�-�c� f' � �, k e"ve- <br />r e c. � S ..�+c <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 />_L <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />I <br />Water heater <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />_� <br />Clothes dryer <br />Water heater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />t <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 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 18.27 RC 'end 296.200 WAC. <br />' <br />Signature of Own er/Contrac uthorized Agent Date <br />J'I"S <br />