Laserfiche WebLink
Y <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES 6 <br />` �7 �D <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - wwv+.everettwa.org g O S /Z <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE 4Z:;- YN-(+71 <br />p n�1 <br />liC ��1lh, l,l�� /RAN5l7- %Kr /f la i; DaCS•.y KJ 3''3SB_34 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />J+Xnlc.I� <br />lr[m,m�:tip /!?i9w5li <br />CONTRACTOR- �ADDRESS CITY/ZIP PHONE �i'S--i-•L+� C .�L s^^^Vrcrr+tc—��.'-"t`I�L7Z. ��_K�E o-7 <br />CONTR. LICENSE # <br />2 <br />` • <br />USE OF BUILDING <br />HEAT SOU CE CONTRACT PRICE OF WORK <br />Electric —Gas —Other /J!/ ,5,�3, 07 7 <br />C- <br />WORK DESCRIPTION <br />7r�. a«!a'r �cc�r c� p b�" f..5 r, �rl.rer Sy57oti' <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />AiC - air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />BackBow prevenler <br />_ <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />_ <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be tree and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date 1/Z <br />J <br />