Laserfiche WebLink
FrR;�11T APPLICATIvN <br /> CITY OF S:VERETT PERMIT SERVIGES <br /> :i290 C_DAR STREET, EVERETT, WA 98201 <br /> •125-257-88'�- FAX 425-257-8857-www.everettwa.org <br /> APPLICA7'ONS ARE ACCEPTED FROM 8 AM TO 4 PM I� ` a-U��� <br /> SITE ADDRESS PARCEL iAX I.D.# PERMIT# <br /> �-y�,o Ev z�,� 1�JJ�,� _ �o� � 1 -r�, a <br /> LEGAL LOT ND. BL�CVO TRACT OF 5UBDIVISION# <br /> DESC. <br /> OWNER ADDRE�S CITY/ZIP PHONE <br /> �JTFl i�CE� �nIC� �� ���'(� �t1ElL�2�aJ� �vdzEfl ��Z03 C(n2'S,434�9�1 <br /> TENANTNAME C�`�TY�'�`FOR'�'�MIT PHONE4z' [}ZZ[pS�Z <br /> L` :< .�F�7Vlti1� i��"Ct <br /> p0\�✓�-�� � 12.� JI�R�j7 � E-MAIL <br /> CONTRACTOR ��lIUR��� �— CITYIZIP PHONE <br /> P�2�C-.,`?L.vwt(8��';'.�;.��. lq�°( 19ilc"�;:.1'n�b'�2t� S�loti.rn:s�k �82Ro 3�a2toz`/33 <br /> CONTR.LICENSE#�`, `- J� :��� -, � ;� ' <br /> USE Uf Lu'�t DING I — HEA7 $C�1'RL� �ONTRACT PRICE OF WOFK <br /> �� ,J�(Llr2�. flnr��:-,ic _ {:�is_�inur (O� CXX� <br /> WORK DESCRIPTION �)(�y.1�j��-.+"-���;_ <br /> Yh�3`v � W� u.a�.� '�+rhi iz��P2�,� ([��'�ovvsnA,rJ�56����cEs�Zu(C <br /> PLUMBING MECHANICAL <br /> NO. � TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Z Toilel PJC-air hardling unils <br /> 6athtub Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kilchen sink& disposal Gas fireplace <br /> Dishwasher Gas rango <br /> Clothes washer Clothes dryer <br /> = Water healer _ Range hood <br /> �_ Sink (service/bar/mop/etc.) _ Exhausl fan <br /> Back(low prevenler Heal pump <br /> Urinal Unil heater <br /> � Drinking Founlain _ Boiler <br /> � Floor drain _ Refrigeralion <br /> Grease Irap Woodslove <br /> Roof drains O!her <br /> Other <br /> CIT'OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I hace read and examined lhis application and kno�v the same to�e lrue and correct. All provisions of laws and <br /> ordinaces governing lhis type of work will be complied wilh whelher specified herein or nol.The granting o(a permil does not presume <br /> lo give aulhority lo violale or cancel the provision of any olher state or local law regulaling conslruclion or the pedormance of <br /> conslruclion That I am authorized by the owner o(lhis property�o perform the work{or which application is made and I comply with the <br /> State Conl ctors La:� 1 7 RCW and 96.200 WAC. <br /> ��, // v DY� <br /> SignaWre of n , onlractor Authorized Agent Date <br /> ��J <br />