Laserfiche WebLink
�{ — iZ—o(o <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—vdww.everettwa.org <br /> '7�� i,4 �OOS <br /> APPLICATIONS Akc ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> •L'lo`t Go�P�Y 4.UL=, A-3`�11 (�2� D1'� ODU`f� �/ -�3 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> h�r�r �-c�n�r.- $o �w �2�'i �v���rt n�Za.-, <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Gr�iauU�t�- C��[z-��� 1���a l'-�c�C-Fc�r� �0 5 �[1`� zZo�- <br /> CONTRACTOR � QDDRES� / CITY2IP PHONE <br /> CONTR.LICENSE# ��K�I'�'(GL' �� ��� <br /> USE OF BUILDING HEAT SOURCE CON'�RACT PRICE OF WORK <br /> 1i.9\�CU�"`�7 �CL�I=CoN� �' ���°`� <br /> Eleclric Gas Olhor <br /> WORK DESCRIPTION <br /> �rPv.c� G� �X l'�TII�L1 N�r�r1,�.7 lr� m-1 � �Lu? An�l'��a.s <br /> h�a � NCW C•tiV�i��ts �N� 1 FVN� C���,�r . 1'�M�iJE <br />' 'L Cx �'�T�1s ca C.��u��r5 <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEh1 <br /> Toilet A/C—air handlin� units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas pipinc� <br /> Shower Waler healer <br /> Ki;chen sink 8 disposal Gas fireplace <br /> Dish�:asher Gas range <br /> Clothes washer Clolhes dryer <br /> Water healor Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> DackBo�v prevenler Heal pump <br /> Urinal Unil healer <br /> Drinkinc�Fountain Doiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> Roof drains Olher <br /> Other _ <br /> CIN OF EVERETT LOCAL SALES TAX COOE IS 9105 <br /> I hereby ceritify lhal�have read and examined lhis application and know the same to be lrue and wrrecL All provisions o(laws and � <br /> ordinaces goveming lhis lypo oF work will bo complied wilh wholher specified herein or noL The granling of a pertnit does not presume <br /> lo give aulhorily lo vi:lale or cancel lhe provision of any olher stato or local taw rec�ulatinc�construr,lion or Iho performance of <br /> construction.That I am aulhorized by tho owner o(this property to perform lhe�vork for which applicalion is made and I comply with the <br /> Slate Conlraclors Law 18 27 RCW and 296.200 WAC. <br /> �i'J <br /> Sign�f wn, o trac or Authorized Agent Date <br /> ��2 <br />