Laserfiche WebLink
� <br />� � -- F�RMI� ,4PPLICATI�,fV -- <br /> �` CITY OF EVERETT PERMIT SERVIGES <br />;?�,�;,�f, 3200 CEDAR STREET, EVERE-fT, `.NA 98201 /� /�1 J <br />� -. ' 425-257-8810- FAX 425-257-8857 -www.everettwa.org /��V I �I <br /> �; , 1 <br />�� ��s , i <br />� APPLICATIONS AFE ACCEPTED 'ROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> Yl ` <br /> M H ! - <br /> ° �;1 SITE AD�RESS � PARCEL TAX I.D.� F�Riy117 A � <br /> ' �o S �/ �� ST ���i <br /> k��,�"'� � LEGAL LOTNO. 8l.00K TRACT <br /> p �:-� : � 6 'C�-.�-� <br /> .I�t,�� DESC. t — <br /> �?Y--,j ' OWNER ADL`RESS CI7Y/ZIP PHONE <br /> , `,i��'� I, 1��,�' %°t.r-"-R" �(LLC `�p���� �io [.!!�-,�4T, y823 G .lGu -3yi- '/6oy <br /> w, — <br />-� i ��" . TENANT NAME CONTACT F`JR PERMIT PHONE <br /> ,� . T.� .CJ:.�, .3 �� -Y2 9- /933 <br /> e. i`�- <br /> ?�!"�- CUNTRACTOR�Q 0 /''n�� (�z.,a._.e� L L c AO�RESS CITY2IP PHONE <br /> r yb z.� � <br />����J i CONTR.LICENSE# /� 0 �o <br />, ., , :, � � X 9/o GPs-,� 36� - 3 s�i - `/G o�� � <br /> � h f'A�ek� �c � oiZcQ <br /> `w. .,' USE OF BUiL�ING HEAT SOURCE I CONI'.RACT PRICE OF WORK— I <br /> ""�;-c5 „,y�� <br /> �s" `i ��`� ' � d�'""7 _Electric X Gas_Other I 9 � �v U <br /> � ?� / _ <br /> WORK�ESCPIPTIO ,-- � <br /> � _ <br /> /V.f-�J .����-r�• S F�' -'� ��' ��. ,_ /_. - <br /> ;�" , � �i d "- � �3 <br /> �3� <br /> PLUMBIidG MECHF+NICAL <br /> � H�. TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR IT[M <br /> I3 Toilet A/C-air handling units <br /> ' 2 Bathtub ! Forced air systems <br /> d'X� Lavatory (wash basin) ,3� Gas piping <br /> � Shower _� Water heater <br /> I Kitchen sink&disposal / Gas fireplace <br /> I Dishw2sher -� Gas range <br /> � Clothes washer � Clothes dryer <br /> Laundry tra� � Range hood <br /> Sink(senlce/har/mopletc.) �I Exhaust fan <br /> _L Backfiow prevanter _ Heat pump <br /> Urinal Unit heater <br /> I Dnnking Fountain Aoiler <br /> IFloor drain _ Refriyerai;on <br /> _ Grease irap = Woodslov9 I <br /> Roof drains Other <br /> _ Other —_ .— II <br /> I — <br /> � CITY OF EVERETT LOCAL SALES SAX CODE IS 3�CS I <br /> I hereby ceritify that I have read and examined this application and know the same tu be Vue and correct. All provisions of laws and I <br /> ordinaces goveming this rype of werK will be complied with v:hether specified herein or not. The granting of a perrt:it does not presume <br /> to give auti�onty to violate or cancel lhe provision of any other�tate or local law regulaGng :onstruction or the performance of <br /> construction.That I am authorized by the owner of this property to per.`orm ihe work for wh ch application is made and I comply with the i <br /> I State Cory�ractors Law '18.27 RCW and 296.200 INAC. � <br /> I +' "' � w/ /� .l ' �`'� i�/Z /Or_ <br /> Signature of OwnedContractorlAuthorized Agent q'3te (��� - � <br /> :`i <br />