Laserfiche WebLink
I <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �� <br /> 3200 CEDAR STREET, EVERETT,WA 98201 .Gx � <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org /�/�j ��� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � 1 <br /> SITE ADDRESS PARCEI TAX I.D.i PERMqT� <br /> ;�,�, G �j r;:./rrs liven��� UC '�� � 1 `-1 � Gscc 5�u L%3U`—I —�II <br /> LEGA LOT NO, BL CK TRACT OR SUBqVIS10N� <br /> DESC. � ���� � '�� <br /> OWNER I1�DRE55 CfiYTP PMONE W,�S-JSj'.7$��J <br /> ��i � �li � �. Kf��ir � �� �, � y Cn�i',o) �llPil�:F LUP�ttj 95ao1 <br /> TEN/A�NT NAME I CpONTACT FOR PERMR PHONE I.�Z S-. ;;S'f _Z S U y <br /> 1"l7i ��;�� /��i �I,� � l �l i �� �f 1�4 f7P/ E-MAII f'6� l- lf./vlu. h>t,�.0�.rc. <br /> CONTR.110ENSE M <br /> USE OF BUILDING - I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �,ii Jlr '�z.i.ri/y hc� . <br /> q � 1 �leclnc __Gas._Other �'� ���`' <br /> /l P 5 � � Qrt P C <br /> WORK DESCRIPTION <br /> �' ✓��.:i c�P.'. k wt /'Pur G�-f' /+tvj� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FlXTURE OR ITEM N0. TYPE OF FlXTURE OR REM <br /> Toilet AIC-air handlirq units <br /> Bathtub Forced air systems <br /> __ Lavatory(wash basin) Gas pping <br /> Shower Wator healer <br /> Kitch�n sink&disposal Gas fireplace <br /> Dishwasher Gas ranga <br /> Gothes washer _ Clothes dryer <br /> Waler Imalor _ Range hood <br /> Sink(serviceibar/mop/etc.) Exhaust lan <br /> Backflow preventer Neat pump <br /> _ Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor d�ain Rolrigeration <br /> Grease Vap Woodstovo <br /> Root drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> 1 hereby centity tliat I havn road and examined this appliwtion and know the same to be true and cortect. NI provisions of laws and <br /> ordinaces govemirn,�this rype ol work will be complied with wliether specified herein or not The granling ol a pemnt does rrot presumo <br /> to give authonty to violate o cancel the provision of any olher state or tocal law regula6ng coasWction or the performance of <br /> construction.Th2t I am authorized by tho owner of this property to peAorm lho vrork lor which appiica6on is made 2nd I comply vAth the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> ���� � jfU,G/� '-12- � 005' <br /> Signature ot O�+medContractor/Authonzed Agent Date <br /> �/Z <br />