Laserfiche WebLink
PtRMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 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 <br />SITE ADDRESS <br />is �� • R� <br />LEGAL LOT N0. BLOCK <br />DESC. <br />OWNER <br />TENANTNAME <br />(,�S'a ' �iD �/ <br />CONTRACTOR/�/� ( � A� � <br />�� <br />CONTR. LICENSE�/��� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />TRACT <br />PARCEL TAX I.D. # <br />FOR <br />ADDRESS " CITY2IP <br />� � o �eo� s��31 <br />7"r,��v,'�� <br />HEAT SOURCE I <br />�i'reS'r��/�� b �I <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Back(low preventer , - � <br />Urinal <br />Drinkinc� Fountain �I <br />Floor drain <br />Grease Irap <br />Roof drains 1� ��\ <br />other <br />Eleclric Gas Other <br />� _03 �6 <br />PHONE <br />CONTRACT PRICE OF WORK <br />TYF E OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Cbthes dryer <br />Ranc�e hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigerelion <br />Woodstove <br />Other <br />���� <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y thal I have read and examined lhis applicalion and know the same to be true and correcL Ail provisions o( laws and <br />ordinaces c�ovemine� lhis type of work will be complied with whether specified herein or not. The granting of a oermit does not presume <br />to give authonly lo violale or cancel the provision of any olher slate or local law regulating conslruction or the performance of <br />conslruclion. Thal I am aulliorized by ihe owner of this property to perform the work for which applicalion is made and I comply with the <br />Sla� ctors L/ aw 18.27 R�`�V� a9d 296.200�AC. / V <br />7/_ iD /� ��� <br />�� v;�jG � <br />�cs_E <br />