Laserfiche WebLink
PERMI�T APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAF 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 � �- a-� `�� <br /> SITEADDRESS j�11 �'""'�f'� ��p"j PARCELTAXI.D.X PERMITN <br /> / ) <br /> / <br /> E,,j,-�t+ �� rA1�s c�=� Sl�7� co3 0� 7 04 C �C��' <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. � po3 <br /> OWNER ADDRESS qTY21P PHONE �pG 3/O 7�/D(� <br /> �r i c 3 ��}��F 6a 2 ,N ti� 7 Z co NG /5�y' .J"/- �.-.�rvC i✓� `.�.°c�d <br /> TENAN7HAME CONTACTFORPERMIT PHONE <br /> N/fi- I s�o,�r c.�Nl�,,� vas� s° e�y� <br /> CONTRACTOR /��qP,,,.��p /�Y+,�J{ '�„S „� ADDRESS CITYIZIP PHONE <br /> �,;,,od, i,N1 yys v v 3 8 s�o <br /> CONTR.LICENSE M 6 oL� 7 C'y .�G I � NE r D L` �'riit 1-✓•=1 `)BoSC� <br /> USE JF BUILDING I HEAT�OURCE I CONTRACT PRICE OF WORK <br /> ,5j^,��e �� I��J�� � _Electric �Gas_Other °��O 0 0� <br /> WORKDESCRIPTION/ �.._��� r,�� ) ��PU�a-h.+�� n�l�^/aen,1 , ��Yi4--� <br /> r2tFL//M}�iv� Y�C,f,_ P/�M/ lNJ lM/I� � f Fn�—C! Gt /\•� �CP1�.^� f4lf�a... � �tt�..J Sk�/.� <br /> / � ' <br /> �✓t'N/ pt6(� , �A�N{ i,a� n,{�,✓ c��7L�f1 � ,5�,-�.�-�4/ � (.��L+,NJ �f r+w ���-ri�1 . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �_ Toilel ± A/C-air handlin� units <br /> _� Balhlub I Forced air systems <br /> '+ Lavalory(wash basin) _ Gas piping <br /> + Shower Waterhealer <br /> 1_ Kilchen sink&disposal _ Gas tireplace <br /> �_ Dishwasher _ Gas range <br /> Cblhes washer Cbthes dryer <br /> Wafer lieater � Range hood <br /> Sink(service/badmop/etc.) � Exhausl fan <br /> BackOow prevenler �_ Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Re(rigerelion <br /> Grease irap _ Woodslove <br /> Roof dreins Olher <br /> Clher <br /> CITY OF EV[RETT LOCAL SALES TN(CODE IS 3105 <br /> I hereby cerilify lhal I have read and examined lhis application acd know ihe same to be true and correcl All provisions of laws and <br /> ordinaces governing lhis type of work will be complied�vith H�helher specified herein or not.The granling of a perrr�it does not presume <br /> to give authority to violate or cancel Ihe provision o(any.�:iier c�ate or local law regulaling consWction or lhe performance of <br /> construction.That I am avthorized by the owner of lhis property to perfoim the work(or which application is made and I comply wilh lhe <br /> Slate actors Law A.27 RCW 2'.36.200 WAC. <br /> ��l dYU S/g�o6 <br /> Signat of Owner/ConlractorlAuthorized Ac�enl Date <br /> ti <br />