Laserfiche WebLink
�ERMIT APPLICA�ON <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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PEkMIT# �z'�3 <br /> � 'S/� �Vt.f e G✓�1 — <br /> LEGA LOTNO. BLOCK TRAC7 � <br /> DESC. <br /> OWNER . ADDRESS CITY2IP PHONE <br /> Br�i�✓ Frq;ve.v /laG7Z �f2.�- 7S�/- Sof4 <br /> TENANT NAME I CONTACT FOR PERMI7 pHONE <br /> p wA L ,ve S�L�� Ftio I, yrs- �76-8 F 3� <br /> CONTRA TOR D ADDRESS CITY2IP PHONE <br /> UGfry J4to�y <br /> / 7 Y 00 /����SoN �VLr.FF /(13= 77C- $Ff 35 <br /> CONTR.LICENSE# �G fr R•a�9 G-� <br /> rN[o7]cM <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> G 9 r �a'F Electric Gas Other -� �Soo �� <br /> WORKDESCRIPTION �N�+�� �Z ` �,F Sfv C4Sr'�.�fs � C�� S�'F oF NoGf L�H�rS <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air h2ndling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen sink&disposal Gas fireplsce <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heatpump <br /> Urinai Unit heater <br /> Drinking Fountain Boiter <br /> _ Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES SAX CO�E IS 3105 <br /> I hereby ceritify that I have read and examined this applicatlon and know the same to betrue and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The grantinc�of a pertnit does not presume <br /> , to give authority to violate or cancel the provision of any other state or local law regulaGng construcdon or the performance of <br /> construction.That I am authorized y the owner of this property to porform the work for which application is made and I comply with the <br /> State Contractors La .27 an 296.200 WAC. <br /> _ z-/6-�s� <br /> ! Signat r eqCo ractor/Authorized Agent Date <br /> I '/a <br />