Laserfiche WebLink
�.. <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEUAR STREET, EVERETT, WA 98201 6 � 13_ U � <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM SE/'f l�S"��o <br /> SITE onDRESS � PARCEL TAX I.D.q PERMIT# <br /> � :� ? �401. [b �J7���� <br /> � .�,� � Clf/f�Gt'J1J �a3 �!-00000�ioo �20� <br /> LEGAL LOT NO. BLOCK TRACT �� �� � C <br /> DESC. <br /> OWNER A�DRESS CITYIZIP�&.��ZPHO E <br /> C�o„a TNEy �o�,2r �LC /4�G D'] .Fy i2 r� 17e S�, /qic.c�¢e� W� �zs •35 9- 6�8� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ( �NA�cES MDQLA� �2J-353—e2Bag <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � <br /> S�N�L� �����y /pcJNNomE _Electric �Gas_Olher �`�pod <br /> WORKDESCRIPTION e��.�reLCY �S ��NG�E �RmiCY �owl�«'�T6S ��/ji�.t � <br /> �5, �, -r��, n�� ���, - 7y� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIxTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet � A/C—air handling units <br /> 1 Bathtub � Forced air systems <br /> _� Lavalory(wash basin) �] 7'a Gas piping <br /> Shower � Waler heater <br /> � Kitchen sink&disposal � Gas fireplace <br /> / Dishwasher � Gasrange <br /> � Clothes washer / Clothes dryer <br /> _ Laundry tray � Range hood <br /> Sink(servicelbar/mop/etc.) g� Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Rooi drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify tha�I have read and examined this app�ication and know lhe same to be true and cortect. AII provisions of laws and <br /> ordinaces geverning lhis lype of work will be complied with whelher specified herein or not.The granting oi a permit does not presume <br /> to give aulhoriry ro violale or cancel the provision of any other slate or local law regulaling construction or the peAormance of <br /> cons�ructioa That I am authorized by the owner of lhis property lo perform the work for which application is made and I compiy with the <br /> St�te Conlrac�ors Law 18.27 RCW and 296.20�WAC. � <br /> �i� S C� ti.� 23 kPiL 07 <br /> Signature of OwnedContr odAuthorized Agent Date <br /> �IL <br /> � <br />