Laserfiche WebLink
SITE ADDRESS <br />�I <br />LEGAL LOT NO. <br />DESC. i , <br />T���u� ' <br />TENANTNAME <br />PEf2MIT APPLICATION <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 TO 4 PM �a -/�- O 6 <br />PARCEL TAX I.D. # Q PERMR p <br />5�,�<>.�LN. �o y7 / i� /�/i(i� � /Q� (ntfli -li�i� <br />BLOCK TRACT <br />tJ � D �� <br />'/l,a„ S, �� l-� S�C o v <br />CONTACTFORPERMIT <br />�`�Cr.V � ��l �I <br />CONTRACTOR I� ^NSC yCK <br />� �, <br />CONTR. LICENSE p , . _ <br />USE OF BUILDING <br />� I� <br />WORK DESCRIPTION <br />I � �� l ADDRESS <br />r '`I�Trs INC • <br />zi n-o Pv.,3ox <br />ciivur rnvne y; t= fS}��y <br />s � s�c � L�v . .�v�.r,u,,3y- <br />PHONE <br />SI��K <br />CITY2IP <br />�306� ,� <br />HEATSOURCE <br />_ Electric � Gas _ Olher <br />l�-9Th1�L�.��l.� ��r�'„�4r�N5 <br />S�r� � �� <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toile� <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Wa1er heater <br />Sink (service/bar/mop/elc.) <br />�ackllow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grcase lrap <br />Roo( drains <br />Olher .- _-- _- <br />-�7o-yylz <br />PHONE <br />�l zs 8� o � <br />CONTRACT PRICE OF WORK <br />� <br />I,� I�1�'�-t �N f'cX� S��u�- <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C-a�: �iandliny unils <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gas range <br />Clothes dryor <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. Ail provisions of laws and <br />ordinaces governing this lype o( work will be complied with whether specitied herein or not. The grenting of a permit does not presume <br />to give aulhonty to violale or cancel the provision o( any other stale or local law regulating cons6Uclion or the pedormance ot <br />construclion. That l am aulho�ized by the owner o( this property to pedorm the work for which applicalion is made and I comply with the <br />Slale Contraclors Law 18.27 RCW an 296.200 WAC. <br />� �' ' � lo- l�-o(� <br />,� <br />SignaWre ol Owner/C � traclor/Authonzed Agent Date 1 <br />IL <br />