Laserfiche WebLink
C� <br />PERMIT APPLICATION <br />C� 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 06 <br />SITE A&R S PARCEL TAX I.D. # TP <br /># <br />Q§*M A oLa5:) Q v �4-Cc61 00 Ole cy (r <br />LEGA LOT NO. BL CK TRACT OR •SUBDIVISION.# l DESC. �Uo -j Y� '��1Q 'I <br />OWNER 1 �jG a --TO CITYIZIP, PHONE <br />LI 3 p --L45 4 -c�) <br />TENANT NAME CONTACT FOR P RMrr PHONE3&t2 L} 5 I jif <br />Tn t c, . N SC n <br />e�CONTRACTOR, E-MAIL i <br />UFFYIZIP MUM <br />CONTR. ICENSE # <br />USE O UILDING i HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric Gas _ Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />Bathtub l i <br />Lavatory (wash basin) T f q <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />I Forced air systems <br />_-3- Gas piping <br />i Water heater <br />Gas fireplace <br />Gas range <br />I Clothes dryer <br />I Range hood <br />n e2 Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 31059` <br />`i <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 />ordinaces 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 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />