Laserfiche WebLink
PL�IVIIT APPLICATIC�' <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 - DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />i��> 32 ^'a �;����- !�c �¢.3 `�i � ..��lv 11�'t�y ( �-c � k� <br />LEGAL LOT NO. BLOCK TRACT --- <br />DESC. �,� �ii'iL<./ / , .3�Cv � ;j . - � �� t . / _ � �- , l/ <br />OWNER ADDRESS CITY/ZIP PHONE <br />i-/��i/is,1�c✓ Tfr2C?,iJ'D� �C� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />�/,✓�✓�.���,v�,%oc� � �%�>,��j �'�CG/s,��� y _� ss�.=� =���� <br />CONTRACTOR /f�������� �` ADDRESS <br />/7 � Gz �I� /Z�� <br />CONTR. LICENSE # ��� j T� � �� �' /� � <br />}Fi <br />USE OF BUILDING HEAT SOURCE <br />�"l ��`` � �`�" �L `�'�/R �Electric _ Gas _ Other <br />WORK DESCRIPTION � <br />�� ��� � j� � � �` .�✓y� �'-�� 76vE/ C/✓r�r ;� <br />L'cd.!,rr �'-/c=.- rir/� /i� /��tl 6 4%��/� r�r�[r�,�"� <br />/�?N' fl �i�-� ��.5� � <br />� <br />IIr11:f I► [�', <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <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 />' P ONE <br />�C,vl.i ,fi `��� �G �J': <br />CONTRACT PRICE OF WORK <br />��� �� -- <br />�j� �,�� <br />�/�=�s c:/� i ���� �� <br />HAN I CAL <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Co Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />C1TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 regufating 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 />`�--_./��'����a-� � , �lG,� /2 �` � ' <br />Signature of Owner/Contractor/Authori d Agent Da e ,�, <br />, ) <br />t�•��,/ <br />