Laserfiche WebLink
1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI7# <br /> �St e�11U �qol la ►�doa�5 �' - �� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. �a � � QCucrc`� � 1� � .5 LO�' <br /> OWNER AODRESS CITY/ZIP PHONE <br /> �1�111� I�� la -�'�'SoN �Slq. C � � 101T Evcr�� r�6G 9"7'3G143 <br /> TENANTNAME p�„f..�tJ� �jQNTAC,TFORP�RMIT PHONE�od-9'� `�3/S`� <br /> �� ' � , Qkc�f��n� /�lcrV'r� 'N r�i�E�-MA-,v� <br /> VI �1 G L� �j� E-MAIL <br /> � CK /��/I-�1 Ow^F`'' �-bd 7� �6/�� <br /> CONTR.LICENSE# ���`-' I <br /> USE OF BUILDING HEAT SOURCE �ONTRACT PRICE OF WORK <br /> �,d� ,�.,��, �4��.5C �Electric _Gas_Other <br /> WORK DESCRIPTION <br /> �\��j._":\vv� 2- V� G-v�r..� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �� Toilet A/C–air handling units <br /> BalhWb Forced air systems <br /> �— Lavatory(wash basin) Gas piping <br /> � Shower � Water heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> �_ Sink (servicelbar/mop/etc.) rlyl-� S1lUl� GS�,y[ _j_ Exhauslfan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Foun�ain _ Boiler <br /> Floor drain Refrigeration <br /> Grease�rap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerfify ihat I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not.The granting o(a permit does not presume <br /> to give authority to violate or cancel ihe provision of any other state or local law regulating construction or the perfortnance of <br /> conslruction.That I am authurized by the owner of this property to perform the work for which application is made and I comply with lhe <br /> Sla�e Contractors Law 18.27 RCW and 296.200 WAC. <br /> �,/V''1 1�� ��1�L�'JE�%]*f"� � 0 ' � — � � <br /> Signature of OwnedContractor/Authonzed Agent Date � <br /> I� <br />