Laserfiche WebLink
( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES /p_�-�--pb <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-,.357—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM , �,� �/� <br /> SITE ADDRESS PARCEL TAX I.D.p PE IT# � <br /> 0o a -�� st oo i y8o iyo �/% <br /> LEGAL LOTNO. BLOCK TRACT \ / <br /> DESC. �a 7� 40 � O ��t f e'fC Euer <br /> JWNER ADDRESS CITY2IP PHO <br /> -CG�ry f f�n�fa �sano /qai/ gg� Avc NE _ A�/i„a�,Fy9e�:3 3Go-43S-7oGS <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �q I �Grry �rq o 3Go- y3S- �o6S <br /> CONTRACTOR ADDR SS CITY/ZIP PHONE <br /> �G✓iltr' <br /> CONTR.LICENSE a <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> n _Electric �Gas_Other �/`��y� <br /> S�nl(.-iti fArv��uf �.ESi �n1c.� =r�-��gd,�+� <br /> WORK DESCRIPTION <br /> ,��w S F/� <br /> PL MBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel %/� A/C—air handling unils <br /> / Balhlub % � Forced air systems <br /> � Lavatory(wash basin) �., �� Gas piping <br /> � Shower _ / Waler heater <br /> _L Kilchen sink&disposal _L Gas�ireplace <br /> �_ Dishwasher Gasrange <br /> � Clolhes washer �_ Cblhes dryer <br /> �[_ Water heater � Range hood <br /> Sink(service/badmop/etc.) �� Exhaust(an� : - <br /> _ Backflow preventer ._ Heat pump � <br /> Urinal Unit heater <br /> _ Drinkin� Fountain / Boilar <br /> Floor drain ✓ Retrigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify ihat I have read and examined lhis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming lhis type of work will be complied wilh whether specified herein or nol.The granting of a permit does not presume <br /> to give aulhority to violate or cancel lhe provision of any other state or local Iaw regulaling conslruclion or the pertortnance of <br /> construclion.That I am authorized by lhe owner o(lhis property lo perform lhe work for which applicalion is made and I comply with fhe <br /> State Con�ractors Law 1827 RCW and 296.200 WAC. <br /> / d4f•--- <br /> Signature of Owner ontractor/Authorized Agent Date <br /> �IL <br />