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r � � <br /> i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, f:VERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-d857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADORESS PARCEL TAX I.D,p PERMIT � <br /> ( W CPS�a�o p,�k�p - 7 o�d651 D 101 Q 70� - � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITV2IP PHONE <br /> �o�v,�11.sE't' �,�.k Cd�oorn�cJ��Ms 143� wCps►►� �V �ff.RCitC °I82o�} <br /> TENtiNT NAME 1CONGTA'CT FOR PERMIT,nJ-f � " PMONE � fpeZ �I I <br /> � 1'��'. I JI1/1�IWG�Y1. k(�1.�1� 'TM`� '^'�•MAILJIM(�@�JWl��iF}Ql4S. <br /> C � <br /> 't$D <br /> CONTR.LICENSE X <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> -- - °` 2�50 <br /> (,0��1�1i���m [lectric Gas Other 0� ��� <br /> WORK DESCRIPTION � <br /> ��E � ��� s►�"sc� t'�'� � r�La� �uJ�� �a�rzs <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FII(TURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toilet " • • � •� �• '� � �� . _._ A/C� air handling unirs � <br /> g;�����i�b __ Forced atr syslems <br /> -- - Lavatory(wash Lasinl ---_ Gas pipinp <br /> — Showei __ Water heater <br /> Kilchen sink 8 disNosal . _ Gas Greplace <br /> � Dishwashcr __ Gasrange <br /> Cbthes washer __ Gothes dryer <br /> Waler heater ___ Range hood <br /> Sink(service/6arlmop'e�c.) __ Ezhaust lan <br /> Backllow prevenler _ Heat pump <br /> Urinal _ Unit hcater <br /> Drinkinq Fountain __ Boiler <br /> FIOor dra:n ___ RefrigCralion <br /> Greasr, trap Woodstovo <br /> flool drains . Other__ __ <br /> -- -- Oiher _ _ __ <br /> CITV OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceritily�hat I have read and examined ihis application and know ihe same to be I�ue and correct All provisions of laws and <br /> ordinaces goveming�his type of work will be compGed with whether specilied herein or noL The granting of a permil does not presume <br /> to give aidhority lo violale or cancel Ihe provision ol any other state or local law regulating construction or the performance of <br /> constiuclion. Thal I am aulhorized by the owner ol Ihis property lo perlorm Ihe work lor which application is made and I compty vnlh the <br /> SI Coniractors Law 1827 RCW and 296200 WAC. �jp? <br /> (� U� 23 — <br /> � nati c of O im: onlractonAuthorized gent ate //�1 <br /> / <br /> C_ <br />