Laserfiche WebLink
i &1. Z� <br /> PERMIT 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 /> CC��J APPLICATIONS ARE ACCEPTED FROM 8 AM f0 4 PM ���� -'ID <br /> .J <br /> SITE ADORESS .eQ P��A,RCEL TAX I.D.S / - n'l P MIT A <br /> ':..a 1 7�r:) �� 1.J LGL-� D .lJ /!lc/ � —� <br /> LEG LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITYIZIP PH,k1E <br /> ;JQcI J^C�f-� i sz�_w.� G �n L:,� �G LL�/ `��3' ��,`17��Jt S zo„�-J-k �1���5 L'a�t �:C � Z�5 <br /> �CONTACT FOR PERMR PHONE <br /> TENANTNAARE 2 '�C:.� ���Z2 .3 <br /> ��G��,�,�� /��� ��0.+=�� .��.,.,.es F,�:_.�., y S <br /> CONTRACTOR ADDRESS CITY2IP PHONE � <br /> !Jor}M.,.�e3'{- I�„��•)I,..� fy� F�-J' ti�otw -rt�, �e.kv,. `iYoa7 `-iz� lSi �j" <br /> CONTR.LICENSE# <br /> h1 �C'� Tk�`1N2.7Sf � (�7�: 1�� 5�2ti1� <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��fZ�,,,,,,` _Electric _Gas_Other "! /c,� c��� � V� <br /> WORK DESCRIPTION ��������. <br /> lr('ji, 11 r•_1\zf �a<k�^5 �17�1'-`�G" <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fIXTLRE OR ITEM NO. TYPE OF FIXTURE OR ITEAA <br /> Toi�et _ A/C–air handling units <br /> Bathtub _ Forcedairsystems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink 8 disposal _ Gas firepiace <br /> Dishwasher _ Gas range <br /> � Clothes washer _. Ciothes dryer <br /> _ Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> BackFlow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain ,_ Refrigerebon <br /> Grease Uap — W°°d$t°ve <br /> Roof drains _ Other <br /> Other _I <br /> _I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify that 1 have read and examined this applicatlon and know the same to be true and cortect. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether spedfied herein or not The grenGng of a pertnit does not presume <br /> to give authority to violate ar cancel ttie provision of any other state or lopl law regulatlng consWcNon or the performance of <br /> consVuction.That I am authorized by the owner of this property to perform the work for which applicadon is made and I compy with the <br /> State ConVactors Law .27 RCW and 296.200 WAC. <br /> c --- si3 - t �> <br /> Sign�re O er ontrct /Authonzo Agent ate , I2 <br />