Laserfiche WebLink
i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3�00 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 � a ,D 3 ��!� <br /> SITE AD9RESS PARCEL TAX I.�.# PE MIT# <br /> ,. /p� ,Mh�,.2d flve �v'z/�t� OD�l3 79`�3�'Od 9� � ��d <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. N•!�l� '�d� �38 ��v�s.��:� K' <br /> OWNER ADDRESS CITYIZIP PHONE 3�yO' <br /> f ��4�'1c ZFi�inlv�.� I3�/09 <l�/�1/� N�' /�/b'ZVs�;I/t 9�d7/ f�sQ o�/o� <br /> TENANT NAME CONTACT FOR PERMIT PHONE 3 c,o �s9 ofria <br /> /=i.�p / �-�A�4dS0i�t �'?+?k ��Y�t��,Q E-MAIL/tM�eKFCvI,���a5eon��� <br /> ADDRESS CITYIZIP PHONE r�]C�' <br /> CONTRACZOR �ZI i �it�, ,qve /Vt 1J�4�1 Ct�� 9Ffz� � <br /> LiD lJ qh ��'1�i 71Z�C'7 1 E'I'l f''1 C � / � <br /> CO TR.LICENSE# (� 1/ 3 GO L^S-I � 51G� <br /> �a �.�nv, L� 9b�� � L� ��z%_� /� ti�z- z3z zo1 � <br /> USE OF BUILDING I HEAT SOURCE I C NTRACT PRICE OF WORK <br /> � �`-I S�a .ab <br /> /�P�,IG/�' /�/ _ �l„„��� /Eleclric _Gas_Other <br /> �� I r( /� <br /> WORK DESCRIPTION 1,Q �, k, �zZ¢ <br /> �� +��„-F ¢- �� 14 c P_ �-�X� ST ����f .Y <br /> �� <br /> �' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A�C-air handling units <br /> BathWb _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kilchen sink&disposal _ Ga�fireplace <br /> Dishwasher __ Gasrange <br /> Clothes washer _ Clothes dryer <br /> Waler liealer _ Range hood <br /> Sink (service(bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unil heater <br /> � _ Drinking Founlain _ Boiler <br /> Floordrain _ Re(rigeration <br /> I _ Grease irap _ Nloodstove <br /> Roof drains _ Olher <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby certify lhat I have read and examined this application and know ihe same lo be irue and correcL All provisions of laws ai:d <br /> ordinances governing this type of work vrill be complied with whelher specifed herein or not. The granling of a permit does not presun•e <br /> lo give aulhority to violate or cancel Ihe provision of any other slale or local law regulating conslruction or ihe performance of I <br /> construction. Thal I am autherized by the owner of this property�o perform the work for which application is made and I comply with lhe <br /> State Contradors Law 1P.27 CW and 296200 WAC. <br /> � � ' ll��/ ;�� <br /> � ��ri�Jr` �a',•�!✓ — ' Date <br /> Signatu foer Owner� nhactor/Authorized Agent �/ <br /> ,, L <br /> _ _ � <br />