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SITE ADDRESS <br />�'31"� Rx42e-fel <br />LEGAL LOT NO. <br />DESC. � .F. I,� <br />PEI�MIT APPLICATION <br />CITY OF EVERETT rci2MIT SERVICES <br />3200 CEDAR STREET, EVCRETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />Ave <br />BLOCK <br />�S D- DI <br />PARCEL TAX I.D. # <br />po�,oi ��50 01 O 1 <br />TRACT <br />/ � �-I —D <br />PERMIT # <br />/� G'��7 - 3 <br />Morr�2 �rc,Ui-m�,� ��I�1 Roc�2eF.ellp.✓ Av�e �-uereN-wi� 'ya5 303-3�I4`i <br />TENANTNAME CONTACTFORPERMIT PHONF <br />Pos��v-z l,Uomc+� �Jei-t,Wrl2 SG�dro. I�Ids� �Cap��Gl N��h�tecl� ��I�S) 31-7-8�17 <br />CONTRACTOR S� N.4�JIQf�c� ADDRESS CITYIZIP PHONE <br />330o C4us1-n�-� S�. (yaS) aS`�-�tl�l <br />CONTR. LICENSE N 1 1 r�� L AC�'3K 3�`) � L O <br />�� � <br />� �zrzti- 9 �� I <br />USE OF BUILDING HEAT SOU. �E CON'�RACT PRICE OF WORK <br />v i r��i'`���:� � Electric _ Gas _ Other ,5�� <br />WORK DESCRIPTION <br />-��a(�tT l(.�(��l�t''�� dF �CIS�(�6 ��(�(rE{� <br />To o�(CCs -t- #��r,�T� �� � <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Ballitub <br />Lavalory (wash basin) <br />Shower <br />I(ilchen sink & disposai <br />Dishwasher <br />Clothes �vasher <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Foroed air systems <br />Gas piping <br />N.�aler hCate� <br />_ Gastirepla.e <br />Gas rmigc <br />Clolhes drycr <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unil healer <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES "iAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and kno�v ihe same lo be true and correct. All provisions of la�vs and <br />ordinaces governinc� this t, pe of work will be complied with whelher speci(ied herein or noL The granling of a permil does not presume <br />lo give aulnority vio�ate o ancel the provision o( any other stale or local law regulaling consWction or the peAormance of <br />construction. TI a io ¢ d by lhe owner ol this properly lo perferm lhe work for which appiication is made and I comply with lhe <br />State Contraclor 1 � ailyd'P9fi200 WAC. <br />