Laserfiche WebLink
� P�r�MIT APPLICATION <br /> CITY UF EVERETT PERMIT SEF2VICES <br /> 3200 CEDAR STREET, EVERE!'T, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org � <br /> ��,�, � -U� i <br /> ANPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT $ CREDIT CARDS ARE NOT ACCEPTED I <br /> SITE ADDRESS PARCEL TAX I.U.# PERMIT# � � <br /> �i � �� `�}�`sc G ,� , � �� �� z, �� c � - o � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. ,� I LfFNi /fL•�2 < }� <br /> OWNER ADDRESS CITYiZIP PHONE <br /> ��U �����G<< /�/oi�� ��� ��. -�.�, 4J,a - 98z,�c �zr-z�a sz2u <br /> TENANT NAME � CONTACT FOR PERMIT � PkON'e <br /> ;��c �� 6.-� r1�,{f,_.� �=5= ��� s zz ,� <br /> CONTRACTOR�QQ �iedQ(�re..QC.Cc ADURESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> f'A.e�- c� �' oizt � /'�o %�� Y/o c'�i�...�� w< y'8z�� `f.tJ'z�ssz2x <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �,�„1,�, �-o..+�r��f ��.c�:j Electric �Gas Other �5 J � � <br /> � <br /> WORK DESCRIP710N <br /> ///-�w S_ ,_,..4 �.�..,.J <br /> PL/�u c;-z <br /> PLUM6ING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. IYPE OF FIXTURE OR ITEM <br /> � Toilet A/C—air handling units <br /> 1 Bathtub � Forced air systems <br /> �_ Lavatory (wash basin) ,�_F Gas piping <br /> t�, Shower � Water heater <br /> T Kitchen sink 8 disposal Gas fireplace <br /> / Dishwasher � Gas range <br /> L :;lothes washer / Clothes dryer <br /> Laundry t2y / Range hood <br />�� Sink(service/badmop/etc.) f��� Exhaust fan <br /> _L Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fauntsin Boiler <br /> Floor drain Refrigeration <br /> � Grease Uap Woodstove <br /> Roof drains Other <br /> Other <br /> i — •— — <br /> I CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> II hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> � to give authonty to violate nr cancel the provision of any other slale or local law regulating consWction or the performance of <br /> construction.That I am authorized by the owner of tnis property to perform the work far which application is made and I comply with the <br /> ' State C;�ntracto Law 18.27 RCW and 296200 WAC. <br /> � �����% �-��- o� <br /> ISignamre of Owner/ContractouAuthorized Agent Date �� I <br />