Laserfiche WebLink
P�RMI�' APPLIGA'TIC�N <br /> CITY OF EVERETT PERMIT :SEHVICES <br /> 3200 CEDAR STREET, EVERETT, VJA 98201 <br /> 425-257-8810— i=AX 425-257-8857 —www.everetriva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM i O 4 PM � -- a9.Ob <br /> SITE ADDRESS PARCEL TAX I.O.Y PE�MI�� �� i <br /> / / j v�i <br /> O� /`7r� � <br /> LEGAL LOTNO. BLOCK TRACT � <br /> DESC. <br /> OWNER A�DRES5 CITY/ZIP PHONE <br /> Zt.�CIn�kE , KA�E.'F� � Oqu� / �Ioq H"avr' `�'Z.5=339 -�/0/ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �ASou ,vo�eo�,Pvr, Yt.s- S9o-�8 _ <br /> CONTRACTOR ADDRESS CIN/ZIP PHONE <br /> /lyo�P.Ost�Rotif y�jT..vG # •tL� crLS' I <br /> CONTR.LICENSE# un/n Q n j—,t/QvE NF �u�� OQ��✓ ��G�/O g� <br /> N��SH�q75'l�c�� � i < <� � ��� �� _ <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRIC'�OF WORK <br /> yo/�Jf _Electric �Gas_Other �,��Q_ o 0 <br /> WORK DESCRIPTION <br /> G.�s �-o GAs �.�e.�. � <br /> �,c.L s ysr'�f <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhtut � Forced air syslems <br /> Lavalory(v�ash basin) �_ Gas piping <br /> Shower Waler healer <br /> Kilchen sink 8 disposai _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(serviceNar/mop/elc.) _ Exhaust fan <br /> Back(low preveNer � _ Hea;pump <br /> Urinal Unil healer <br /> Drinkinc�Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> � Roo(dr2ins — I = Other <br /> Other — — <br /> CITY GF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify thal I nave read and examined this application and know the same to be true and correcl All provisions of laws and <br /> ordinaces governing lhis lype o(work will be complied with whether specified herein or not.The 9ranting of a pemiil does nol presume <br /> l0 9ive aulhority to vioiate or cancel the provision o(any other stale or local law regulating conslruction or the performance of <br /> construction.That I am aulhorized by lhe owner of lhis properly to pedorm the work(or which appliwtion is made and I comply with ihe <br /> State Cuntraclors Law 1 ti27 RCW and 296200 WAC. <br /> �3'Z9�01e <br /> Signature of Owner/Contractor/Authorized Agent Date <br />