Laserfiche WebLink
FCRMIT APPLICATIUN <br /> CITY OF EVERETT PERMI� �ERVICES <br /> 3200 CEDAR STREET, EVERETT,�VA 9L 201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# �RM�T� � <br /> ��/v V'�w i�lD� DI��V� (f'o � S3 <br /> �EGA LOTNO. BLOCK TRACGT <br /> DESC. � yII�W l4/UGE /�DIaTII�/� <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Sz,- Z�p-z3a� <br /> I°i�rJ� •� �'/d�r�K �-RC��u�ca�� , �ie � ���i� RrDG-� D(z r�r�r�r���n, �eu3 t: c; <br /> TENANT NAME CONTACT FOR PERMIT PHONE � �� � L,I �. <br /> — ��yv�/��c�ra�---��=��sz-s3��� ��� ��`�,�,�� `��' � <br /> CONTRACTOR ADDRESS � CIN21P PHONE � <br /> � . •� r� C��,,�tRr�t����/� r�Ryr���oN r�U�rr, w�. <br /> CONTR.LICFNSE tl <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � <br /> 7//1'�rGG %/)/1J/�'r _Elec�ric 'K Gas__Olher / yG�G„G <br /> WORKDESCRIPTION �r��N����1Lr if- � /5 � � ��r����K ��� �fe� �f��' <br /> r'l�✓l�if l3/�srry�,'r �Y I3/�r/�-? �•rr��T'-J, <br /> �j/(�/f/c/i/ 1�1'�.11/Gl�r��� 13/fT!!� +j 3�z1�KUGl�rS f{�/�lGD,�L <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet AIC—air handling unils <br /> r Ba1hWb � Forced air syslems <br /> 'r Lavalory(wash basiri) _ Gas piping <br /> 7— Shower � Water healer <br /> � Kitchen sink&disposal _ Gas fireplace <br /> i Dishwasher Gas ranc�e <br /> i Clothes�vasher � Clothes dryer <br /> �_ Waler heater Range hood <br /> Sink(service/barlmop/etcJ ,� Ezhausl fan <br /> Backflow preventer _ Heat pump <br /> Unnal Unil heater <br /> Drinking Fo�mlain _ Boiler <br /> Ficor drain Relrigeralion <br /> Grease trap _ YJoodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby centi(y lha!I have read and examined this applicalion and know lhe same to be lrue and correcl. All provisions of laws and <br /> ordinaces goveming lhis lype ol work will be complied with whelher speci(ied herein or not.The grentiny o(a permit does nol presume <br /> to give aufhoril�to violate or cancel Ihe provision of any olher slale or local law regulaling conslr:clion or the perlormance o( <br /> conslruction. Tha� I am aulhorized by ihe owner of Ihis property lo periorm Ihe work(or which applicalion is made and I comply wilh the <br /> Stale Ca)lractors Law 18.27 RCV�and 296.200 WAC. <br /> G In, ,�'� G,��d��%���� 3�-ay�0� <br /> Siynature f OwnedCon raclodAulhonzed Agent Date I/y <br />