Laserfiche WebLink
,� . <br /> � <br /> �rRMIT APPLICATI�N <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 PARCEL TAX I.D.q PER IT A <br /> 4� U v �:C. <�Pc - :7,��c5- �� u - c3<. .- o < <c, 7 Z <br /> LEGAI lOT NO. BLOCN TRACT <br /> DESC. <br /> OWNER AODRESS CITYIZIP PHONE <br /> l�-��u �cz1:��1�-�.nR���<��> l-l-c ���?,.� -3�(����;r- �',c•�'I��tl �tY;�;;�. �1��>-'1�13-� 1�s <br /> TENANT NAME �-� I CONTACT FOR PERMIT � PHONE <br /> — G"yn� �'� ,'�1�.1 h{�5 ' 'I�I?� l l 1� <br /> CONTRAC70R ADDRESS CITY2IP PHONE <br /> NcLu�C�- � Y1'�: �`)�15ir�.�LIL ��It'S?. -'��i{�`�c;<: �F �?ii't"�lv.���l�Liia, t-1�� lN3 <br /> CONTR.LICENSE N � '� � �� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> '-'.� ��.')�� � r"lL"1�` :t`].�:` �. "� _Eledric �Gas__Olhor <br /> ) <br /> WORK OESCRIPTION <br /> �-) e t�.: c ..���1 4�.�,,. •1�ti-i �.(• , � :a.�.h„�i i. �-�� �ki,.�.` _:L�_,1 i�,L���� <br /> l <br /> ��-� t sq <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TVPE OF FIXTURE OR ITEM <br /> 3 Toilel A/C-alr handlinc�unils <br /> � Balhtub = Forced air systems <br /> _�_ Lavatory(wash basin) Gas pipin� <br /> _�_ Showr.r Waler haalcr <br /> _� Kilchen sink 8 dispusal _I_ Gas firoplaco <br /> J Dishwashcr _L Gasran�o <br /> _[_ Clolhes wa::her _f_ Clolhec dryar <br /> � Walr.r hi�alor _L Rango hood �v�,.p,, <br /> Sink(survice/barlmoplr,tc.) � Exhausl(an <br /> �ackllow preveNer Heal pump <br /> Urinal Unil hcaler <br /> Drinkin� Fountnin �oilcr <br /> F�oor drain Rc�frigeratinn <br /> _ Grcaso Irap Woodslovo <br /> Rool drains Olhr.r <br /> Olher <br /> CITY Of EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hercby cerili(y Ihat I havr. read anA ex;+minoA this application and know Ihe samo lo bo lruo and correcl. A�I provisions of laws and <br /> ordinaces poverning Ihis lype ol work will bo complied wilh wholhor specifiod heroin or not.The t�ranling of a pnrmil doas nol prosumo <br /> to�iv�au�horily�o violatr,or cancel lhe provision o�any oUwr slate or local law requlalinfl conslruction or lho performance ol <br /> const«iclion.Thal I am authorized by Ihe owner o(this properly lo porform the work for which applicalion is mado and I comply wilh lhe <br /> Stalc Contraclors Law 1fS.27 RCW and 296.200 WAC. <br /> �� ` <br /> . , ' ���� v_� 1 Q� <br /> Signaturc;u�l�Ow edConUactur/A� ho izr,d A�enl ale <br /> .__.. _------ - -. . . __.. . � _. _-------------- --------------- <br /> _ //� <br />