|
PtRMIT APPLICATIC�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 � �,Z'Z-0S
<br /> SITE ADDRESS PARCEL TAX I.D.fi PERMIT 1t
<br /> ,
<br /> _, _. - , � :� ; ,,� ,�y. -,,.,� - - . ,cJ��l-��
<br /> ;
<br /> LEGAL LOTNO. BLOCK TRACT , .
<br /> DESC. � �_., ,. .� .i I' .-� � I �., _. �..�' _ . .
<br /> OWNER ADDRESS CITY2IP PHONE
<br /> i �
<br /> � , ,� , �� . F�F� ti � �fz5���-��'�
<br /> `,_.. � , , ' ` , ':r v
<br /> TENANT NAME CONTAC]'FOR PERMI � l PHONE
<br /> , � � ��� , � '���,-� � � ��:Slq-J,v�,C'�•, � ,� ' _ <'�,�� ���-vyzy �
<br /> CONTRACTOR " � ' ' - t%; � 'i ADDRESS � CITY/ZIP PHONE.
<br /> �-1 - : . _. . -. .- . � . ! K� ,+ rl�_On:�;
<br /> ,C _, ;G�O F.� , �
<br /> CONTR.LICENSE p /'i� ��-;� � �'1 r'!� � r �
<br /> USE OF BUILDING HEAT SOURCE , CONTRACT PRICE OF WORK
<br /> . , : r � . � -.�.
<br /> , � ., . , .•;,,_�r � � . . � �Eleclric _Gas_Other � G ,
<br /> WORK DESCRIP710N � / �� 4c F��l�
<br /> {, rl �{.��ni., , '-t s K7 +r� !� / �6 its.! 97`f �
<br /> , , � '
<br /> a i i,
<br /> �,� � '�r���+ r�, ;, �I ,.If� ! � a,h����� 5 �a �r���� � �,Pf�� !E'���'�� I.�It��S ''� c �i•l'
<br /> PLUMBING MECHANICAL
<br /> NO, TYPE OF FI%?URE OR I7EM NO. TYPE OF FIXTURE OR ITEM
<br /> Toilel A/C-air handling onils .
<br /> BalhWb Forced air syslems
<br /> Lavatory(wash basin) _ Gas pipinq
<br /> Shower Waler heater
<br /> Kitchen sink&disposal _ Gas firop�ace
<br /> Dishwasher Gasrange
<br /> Clothes washer Clothes dryer
<br /> Laundry lrey _ Ranye hood
<br /> Sink(service/badmop/elc.) _ Exhaust tan
<br /> 6ackflow prevenler _ Heat pump
<br /> Unnal Unil hcater
<br /> Drinking Fountain _ Boller
<br /> Floor drain Refrigeration
<br /> Grease lrap i Woodstove
<br /> Roof drains Other
<br /> _ Other _
<br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105
<br /> I hereby centify thal I have read and examined this appiication and know the same to be true and correcf. All provisions of laws and
<br /> ordinaces goveming this lype of work will bo complied witb whether specilied herein or not.The granting of a permil does not presume
<br /> to give authority lo violate or cancel lhe provision of any olhr,r state or Iocai law regulating consWction or ihe pedormance of
<br /> construction.Thal I am authorized by lhe owner of this property to perform lhe work for which applicalion is made and I comply wilh the
<br /> Stale Contracto,ry Law 18.2Z RCW and 296.200 WAC.
<br /> ; . �
<br /> � , r
<br /> Signature of Owner/Conlrector/Authorized Agent Date �
<br /> /z
<br />
|