Laserfiche WebLink
�- .- <br /> P��RMlT APPLICATI�N <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 TQ 4 PM p v.a� `�� <br /> r <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> C�' <br /> j �C�/ �C.=-��%�,�r.- '. 'ft_���.- �CO7 �Q-Oc��I <br /> LEGAL LOT NU. BLOCK TRACT OR SUBDI4ISION# <br /> DESC. <br /> OWNER 4DDRESS CITYIZIP PHONE <br /> �I> „ , , /., �,! _ ' � � �� _ <br /> 'Ui.!i , "%� ' r - . ��,.��,( '� %�� � %�'. ��. ?�� j.;'" i'. .i •:�� ' �!/1- . '�����'C.� l)i2� <br /> TENANTNAME � CONTACTFORPERMIT PHONE � <br /> /� /J/�J /�{/, r <br /> �vt I�� � 4�v �.� I �Y�/J�-�� E•MAIL <br /> CONTRACTOR �-- ADDRESS � CITY2IP P ONE <br /> �fI�;!'Y—. <br /> CONTR.LICENSE# <br /> USE OFBUIL�ING HEAT SOURCE , CONTRACT PRICE OF WORK <br /> ,,/� <br /> � c � � I�CtI�.i, ���%Cy� _�>� . ��� <br /> y�� l/� r- ' _Eleclric V Gas_Other Y�,( <br /> 1_ C- ._(��Gc-�: L. (., J <br /> WORK 2)ESCRIPTION <br /> ���S � �� � � <br /> PLUMBING MECHANICAL <br /> NO, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Batlilub Forced air syslems <br /> _ Lavatory(wash basin) � Gas piping <br /> Shower Waler heater/�/!} <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Cblhes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflo�v preventer Heat pump <br /> Urinil Unil heater <br /> Drinking Founlain / Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> y Roof drains. L Other <br /> _ Other,;]'z`5(%lu I1J�lrPl1 �',��<'1 _ <br /> , � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this applicalion and know lhe same tu be true and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be complied wilh whelher specified herein or noL The granting of a permit does not presume <br /> lo give authorily to violate or cancel the provision o(any other stale or local law regulaliny conslruction or lhe performance of <br /> consiruclion. Thal I am aulhorized by lhe owner of this propeAy lo perform lhe work for which applicalion is made and I comply with the <br /> Slale CoMractors Law 18.27 RCW anU 29G.200 WAC. <br /> � <br /> _ ; , - - - - '� ' � / �J�'— <br /> - - - ,- - -, ; �� �y�. , <br /> Signature of Owned onlraclodAuthorized Agenl �Dale � <br /> \ , <br />