Laserfiche WebLink
PERMIT APPLICATION <br /> C�TY OF EVERETT PERMIT SERVICES <br /> 3200 �EDAR STREET, EVERETT, WA 98201 <br /> 425-257-881 D— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� ,.,� —�� <br /> SITE A�DRES3 PARCEI TAX I.D.p PERMIT p <br /> 3.� 1 l r c. � � � �GY' ,'7 C'JG��OC� ' � 711 '�01 <br /> LEGAL LOT NO. BLOCK` TRACT O�.Ry-SUBDIVISION tJ I <br /> DESC. .—� ! f'J T. . c� p; 1 � <br /> OWNER A A U7ESS CITY2IP PHONE <br /> ��e1C�11�� 1� IGLf h / UC�� /��ClT1�4L� V� /V�. ��Ct:+l��tJ � �l�>� LV.4g�e �� <br /> TENANT NAME CONTACT FOR PERMIT QMONF�� <br /> i� 1� 7/ I cl�r;,��rl�r� c.t�rs� cvJ�5)�7v-s83, <br /> /��t.�Y.a�'��`` �(t�� E-MAILx�.n�tM� �r,�eh+Syns c:c.n <br /> �bFdT1iA IT'Y'11f�"� <br /> , �rryslreo.ti'i:,�,�5ys��w�5 740� 1-Inr�sc.� P�. Eactci�l� w.4 48?Oj <br /> CONfR.UCENSEp /'���7,' � ��� <br /> 3 cQC1YNt�r�7C M � <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �C% s.l MC-J C �ea� _Eleclric _Gas_Other � � �� � �G� I <br /> WORKDESCRIPT+ON, �1�.�+aII �1)d•� �I��Srxtc'� t4�ernally•(,� ��`o_�i���� �I�U�'u= sc'f <br /> c-� 110�-���"� /t �VG (e'HC'r i� 9(.Jo FIV�i�a MOJN�r<� 'fo:,�r�,l l, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> /l/�Q Toilet i � A/C-air handling units <br /> Bathlub _ Forced air sys�ems ,k <br /> Lavatory(wash basin) _ _ Gas piping � <br /> Shower � Waterheater � <br /> �_ _ Kitchen sink 8 disposal _ Gas lireplace "r�y'�. <br /> Dishwasher Vas range ��� ,r�,�,J" <br /> Clothes washer Clothes dryer � ti :� � <br /> _ _ Waterheater Exhaust�an �� �� <br /> Sink(service/badmop/eia) _ <br /> 6ackflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigera�ion <br /> Grease Irap _ Woodstove <br /> Roof drains Other______ <br /> - — Olher ------_-- <br /> CITV OF EVERETT LOCAL SALES TAX CODG IS 3705 <br /> I hereby ceritify ihal I have read and examined ihis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming ihis type ol work will bo complied with whelher specilied herein or not.The grenting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or Iocal law regulating construction or ihe pertormance of <br /> constmction.That I am authorized by Ihe owner ot ihis property to perform the work lor which application is made and I comply with the <br /> Statc Conlractors Law 18.27 RCW and 296200 WAC. <br /> /'!�,'��f�.�u� 3/C���C�� <br /> S�gnature�wneuContractor/Authonzed Agent Date <br /> ��Z <br />