Laserfiche WebLink
PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 / <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org � -- !O 3� � � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS �� � PARCEL TAX I.D.� PERMIT X <br /> I`{lON1C����L.C����'Y��� Wp Z`�,C�koL-Go�l--ocS- co `, `!�=`-j _ ,� <br /> LEGA LOTNO. BLOCK TRACT <br /> �ESC. <br /> OWNER ADDRESS CIN/ZlP PHONE <br /> Wi =u,�-�� l'4ct-D��u���C 1��10 bt�-fi-��LC�1=�K-�%K+.�;. L"V[f'�=Ti <br /> TENAN7 NAME I CONTACT FOR PERMIT PHONE <br /> � INT�GR��t=D �r�e�c i D-�i�,�l <br /> I NTL"G T�{=c.�uc•k�c��I�S 1�1G, M��H ne� ��ur���n�eN �u;c:� �} 17 I�} Z�'. <br /> CONTRACTOR AODRESS CITY2IP PNONE <br /> G�t�PH�G�Ii�I.A`�`7lGt�GGMPdn1`l ��5�}5 5�`f�U��'. <br /> CONTR.UCENSE N G R��H 17 L O��Ci �P ��'I l I�L �ZL�),�Oc)�OCC7L� <br /> ��6 �� ��G <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> {�'lb�l'—If1�- �T��7T J��P_� _Eledric _Gas_Other /�Z�i � � `7 v <br /> WORK DESCRIPTION i��L1 1�� / \ <br /> 4 � ��cN <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEla <br /> _ Toilet FUC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposel Gas fireplace <br /> Dishwasher Gasrange <br /> Clothas washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbarlmopletc.) Exhaust fan <br /> Backflow preveri�r Heat pump <br /> Unnal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain _ Refrigerallon <br /> Grease trep Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify thal I have read and exnmined this epplicetion and know the sams to be true and correcl. All provisions of laws and <br /> ordinaces goveming this type of work wi�l be complied with whether specified herein or not.The grenting of a pertnR does not presume <br /> to give authority to violate or cencel the provision of any other state or local law regulating construdion or the parformence of <br /> construction.That 1 am authorized by the owner of this propeAy to pertorm the work for which application is made and I comply with the <br /> Slate Contradors LaW 18.27 RCW and 296.200 WAC. <br /> , /� �_ � �� <br /> � �/'�;U�_ � ,< <�.�c.�vt�su�__ �, �� � �'� <br /> Signatur�wnedContfacrodAuthonzed Agent � Date � <br /> i�o <br /> � <br />