Laserfiche WebLink
P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES ���� <br /> 3200 CEDAR STREET, EVERETT,WA 98201 �1�, <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT# <br /> I 8 � Cu o .�y ooa oo i ou �pl�—�'�(v <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE S8' \ � 1 <br /> J�cK ir.� -�� �F [�o� rr.:c q33o BA�r�oA +etvF SaN q,o�.� �. 9z iz � <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORKI7A <br /> I Electric �Gas_Other � �/��, <br /> 2£SiAI�YL.l�NT — — — <br /> WORK DESCRIPTION <br /> 'rvZ' £'p� op coS nn £'T �C tn p C,12At3� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Toilet _ A/C—air handling unils <br /> Bathtub Forced air syslems <br /> Z Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater ' <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range 1 <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(servicelbar/mop/etc.) _ Exhaustfan <br /> Backtlow prevenler _ Heat pump <br /> i Urinai _ Unit heater <br /> Drinking Fountain _ Boiler <br /> �_ Floordrain _ Refigeratlon <br /> Greasetrap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and conect. Ail provisions of laws and <br /> ordinaces governing lhis lype of work will be complied wilh whelher specified herein or not.The granling of a permit does not presume <br /> to give authoriry to violate or cancel the provision of any uther state or local law regulaUng consWctlon or tha performance of <br /> construction.That I am authorized by the owner of this propert�to perform the work for which applicatlon is made and 1 compiy with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> � .,.-�� �--�'<--- •� � a � c� <br /> Signature of Owner/ContractorlAuthorized Agent Dale S� �4 1I� <br /> V+ <br />