Laserfiche WebLink
Pt�MIT APPLICATIUN � <br /> CITY OF EVERETT P�F:MIT SERViCES <br /> 3200 CEDAR STREET, EVERcTf, WA 982C1 <br /> 425-257-8810-- FAX 425-257-8857 - v✓v✓w.everettwa.org <br /> APPLIGATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI,# / <br /> /d 5/.S . /�. �" � 23 r���1l00 60 !� �f r'� � o� 5 <br /> LEGAL LOT NO. BLOCK TRA T OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS � �7G Q/Z CITY/ZIP PHONE <br /> .�-�-� � �/hC�s /11GC'>�S' Q�ii�i��r.�.,G �' E'ap`y��� ��2 �.3�/ <br /> TENANT NAME � CONTAC OR PERMIT PI10NE �J�� <br /> �,Y'-C' � c S E-MAIL <br /> CONTRACTOR, �.- �� ADDRES v�� /G/� CITY2IP PHO� �p,�,{�-[ <br /> CONTR.LICENSE# � . CO �� ��G ;•. . � -�,) �7 <br /> ,� YPi �r7 � � <br /> USE OF BUILDWG HEAT SOURCE CONTRACT PRICE OF WORK i <br /> i� i <br /> _Eleclric _Gas_Olher �/`.�� Qp. , <br /> (L�L <br /> WORK DESCRIPTION i <br /> III <br /> � /� � � �n�� /.�/ I <br /> ��/�n�/ l`�iv/9 � 'f_� C��i��/i;� � aCiS- MECH NI L I <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A�C-air handlinc� units <br /> Balhtub Forced air syslema <br /> Lavatory(�vash basin) _ Gas pipin9 <br /> Shower _ Wa!er heater <br /> Kilchen sink&disposal _ Gas freplace <br /> Dishwasher Gas renge <br /> Clolhes washer _ Clolhes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> � _ Backflow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> � Grease lrap _ Woodstove <br /> �I Roof drains Other _ <br /> Olher <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify lhat I have read and oxamined lhis application and know lhe same lo be true and correcl All provisions of laws and <br /> ordinaces yoveming lhis type of work will be complied with whether speci(ied herein or not.The granting oi a permit does nol presume <br /> lo give authority to violate or cancel the provision of any olher stace or local law regulaling construclion or the periormance of <br /> construclion.Thal I am aulhorized by the owner of this property to per(orm the work(or�vhich application is made and I comply wilh the <br /> Stale Contraclors aw 18.27 RCVJ nd 296.200 WAC. I <br /> Sign ure of wner 'onlra or/Aulho�Agenl �Q <br /> �_ ---- — i <br /> /i <br />