Laserfiche WebLink
PicRMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettvia.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TG-3 PM S —3 0 —o� <br /> SITE ADDRESS �-y` I PARCEL TAX I.D.# PF,$MIT# � <br /> ,:, ^ ,..� ���� a���s�v�.� ����3 -� <br /> LEGAL LOT NO. BLOCK TRAS:T�JR SUBDIVISION# f 1 ��Y�'t <br /> DESC. �� C ; ��� �_,Gl .A,��cl -•.t u�.S *-r I t- z-#f�C�/T I U L�J <br /> ..., <br /> OWNER • AJDRESS CITYIZIP PHONEyz:i LSS J&�`J <br /> � � _ - �/.�TZ 6� -�-+ � �� `, `� _r.J � <br /> ,__; <br /> -� � <br /> TENANTNAME CONTACTFORPERMIT PHONE �.fZ� Z5G U.�i� <br /> J (''� d <br /> e{--1- �C7U�`i E-MAIL�P,GAV`il-\UMt�L`�' S+J <br /> CONTRACTOR � � ADDRESS--) ITY21P PHO E . � N` <br /> N . ,. .. ' . � 1.,1� :i� . �%,r . .. � . _'.'i'G;: <br /> _, ' , •.-L- � `_i; ` } .�_ �> - <br /> CONTR. LICENSE# . _ - . <br /> r,. <br /> �t ,`iL �__1 �� N 4 C�� ('. . �' _ r_ _ , ', <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> • _Electric ��Gas_Other l �� � ,- },.-� <br /> WORK DESCRIPTION <br /> �J �. , � � �:. _ - � <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AlC-air handling units <br /> "— 8�����i�� I Forced air syslems <br /> Lavalory(��ash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal � Gas fireplace <br /> Dishwasher 1 Gasrange <br /> Clothes washer _L Clothes dryer <br /> Water heater � Range hood <br /> Sink(service/bar/mop/eta) �! Exhaust(an <br /> Back(low preventer _ Heat pump <br /> Urinal _ Unit healer <br /> Drinking Fountain 8oiler <br /> Floor drain _ Re(rigeration <br /> Grease trap _ Woodstove <br /> Roo(drai�s _ O�ner <br /> Other_ _ _ — — <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y that I have read and examined this application and know lhe same lo be lrue and correct All provisions of laws and <br /> ordinaces yovernina this lype of work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> to give authority to violale or cancel the provision o(any other slate or local law regulating construclion or lhe performance of <br /> construction.That I am authcrized by the r,wner of this property to perionn the work for which application is made and I comply with the <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. <br /> �, l� JU <br /> SiynaWre of OwnedContr�clodAu�horizzd Agent 'Dale� � / <br /> �L <br />