Laserfiche WebLink
� <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.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM Fj '�6 �Og <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ��uc,3 m��n,� c��,=�v�' 4v� ��.t-�- .?�S s�oa�ooio o C. � -o - vri� <br /> LEGA LOT NO. BLOCK TRAC OR SUBDIVISION p <br /> oEs�. a sl,e�� a� i 3c 7 <br /> OWNER ADDRESS CITY2IP PHONE <br /> J �r�'a�l� (%�`�,'�t- �yi �� I %� I `�r �tvr °��� �1�.�i��e���.��1�� ��v{ 1 �3��c)��� 0254 <br /> TENAN NAME / CONTACTFORPERMIT PHONE/, p <br /> /�,�' J l,�E,�'�E��'� / 39� <br /> �1��I7L�C L G� W2�1 E-MAIL <br /> RA T R ADDRESS CITY2IP PH E ,� <br /> ( ��.7-�- C.E��n��fi�.��fi�t��� �y i ��v i 31_{� �-,,�e St�; S»�.1��t�`i� �;S4-, �j���l<c <br /> CONTR.LICENSE p � <br /> LO�iC' � zs- S2"���'� rv�';l �-/ 7� - ,� .�(r,�f <br /> � USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��� r �Eleciric _Gas_Other <br /> WORK DESCRIPTION , � � �� ;( C � �,� �, <br /> /3l;f' � SFi� rL/v/t�.r�! �, �� �-i;<< - �C� c� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel ��I /VC—air handling uniis <br /> � Bathtub � Forced air systems <br /> � Lavalory(wash basin) r •�j A Gas piping <br /> � Shower _L Water heater <br /> / Kitchen sink&disposal N�n Gas lireplace <br /> � Dishwasher r%L Gas range <br /> / Clothes washer � Clothes dryer <br /> r: Water heater / Range hood <br /> Sink(servicePoadmopletc.) � Exhausl fan ���� <br /> Backflow preventer _ Heat pump <br /> ��,i Urinal Unit heater <br /> Drinking FouNain rv ia Boiler <br /> Floor drain L Relrigeration <br /> Grease trap __ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceritify Ihat I have read and examined this application and know ihe same to be irue and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied wi�h 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 olher state or local law mgulatinc�construdion or ihe pedormance of <br /> conslrucuon. hat I am authorized by the oyvner ot this property to pedorm the work for which application is made and I comply with the <br /> Stale Contra ors Law 18.27 RCYd an 2y98 200 AC. <br /> ,� / . �> � i'�' ��'�'�%� +��� U��(/�� <br /> Signature of OwnedConVaCtodAuthonzed Agem Date <br /> �'� <br />