Laserfiche WebLink
PE�.MIT APPLICATIOh <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982G � <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 />�_ , , <br />LOT NO. BLOCK <br />%l[/ G9 C� <br />P TIP I U�_ ��j r%it <br />PARCEL TAX I.D. A <br />�G 3 i 33 aaoii�/�: � <br />TRACT <br />i3� �aG'-%�S< cv ,�-�� yz� =33�-�rs � <br />TENANTNAME CONTACTFORPERMIT PHONE <br />/�C x�c � l�� E f T1P� <br />CONTRACTOR j��F ADDRESS CITY2IP PHONE <br />CONTR. L�CENSE # <br />USE OF BUILDING <br />d�lk.u. w a.� rl. <br />HEAT SOURCE <br />� Electric _ Gas _ Other <br />WORK DESCRIPTION <br />���7�u� ,�'�.c ,Cr� . �/�/1, � ,�ct�ic�/ <br />.3�9 C� ���"/ 0 <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 3 disposal <br />Dishwasher <br />Clothes washer <br />Laundry iray <br />Sink (servicePoadmopletc.) <br />BackOow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other ___ <br />CONTRACT PRICE OF WORK <br />`fS�' S S �'- <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit hea;er <br />Boiler <br />Refrigeration <br />Woodstove <br />Other_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby cerilify that I have read and examined this application and know tho same to be lrue and correct. All provisions of laws and <br />ordinaces governing this lypo oF work will bo complied with whelher specified herein or not. The granting of a permit does not presume <br />to give aulhority to violale or cancel the provision ot any olher stale or local law reguiating conslrucNon or lhe performance ot <br />conslruction. That I am authorized by lhe owner o( this property to pedorm the work for which applicadon is mada and I comply with the <br />State Conlractors Law 18.27 RCW and 29�200 WAC. <br />� �n/�/� <br />/ � � ..-/ <br />Sic�nature of OwnedCo� ractodAulhorized Agent Dale \ IZ <br />