Laserfiche WebLink
SITE ADDRESS <br />�-} 5 ,_' ; �� o <br />LEGAL LOT N0. <br />I�ESC. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereltwa.org <br />Fl�P <br />j i�� c..� a S ��'� 1 �, : r� �:� <br />TENANTNAME <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLOCK TRACT OR SUBDIVISION �Y <br />ADDRESS CITY/ZIP PHONE <br />��SC��'� i��OY I l�'i� C�c✓a��i� V✓%� �I �JG j�12�����-`! joi(. <br />CONTACT FOR PERMIT <br />PHONE <br />I E•MAiL <br />COtJTRACTOR ADDRE55 CITY/ZIP PHONE <br />s�..��. ��,,.:tj P�4..,b..,o� ,�o;oh G i�7 c.�,�,�.-1,�,�, ����, �.� �,-;s-��5-�3�� <br />CONTR.LICENSE# S6U 11�C� l� 3C ��)��:^stjl-'<Pi�� -C�T�7 <br />USE OF BUILDING <br />�:>;�1� �c� <br />WORK DESCRiPTION <br />�,�'P�.cJ <br />PLUMBING <br />HEATSOURCE <br />Eleclric Gas Olher <br />�G �i Cf �.rL_ <br />NO. I TYPE OF FIY.TURE OR ITEM <br />Toilet <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Cbthes washer <br />lNater healer <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains , <br />Other v;.��_; �:ce <br />CONTRACT PRICE OF WORK <br />NO. I NPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cbthes dryer <br />Ranye hood <br />Exhaustfan <br />Neat pump <br />Unit healer <br />Boiler <br />Re(rigeralion <br />Woodstave <br />Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I heraby cerili(y �hal I have read and examined lhis applica:ion and kno�v lhe same to be lrue and correcL All provisions of laws and <br />erdinaces goveming lhis type o( work will be compGed w�th whelher specitied herein or not. T:ie granting of a permit does not presum <br />to give aulhority lo viola�e o� cancel the provision of any olher stale or local law regulaling conslrudion or lhe parformance of <br />construr,lion. That I am authorized by the owner of this property to perform ihe v+ork (or which application is made and I comply vrith . <br />Slale Coctraclors Law 18.27 RCW and 2�J6.200 VJ4C. <br />Signalure of OwnedContractodAulhorized Agent Date <br />