Laserfiche WebLink
PEFiMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9II201 <br /> 425-257-8810 — FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERM!T# <br /> ���1��- � . ,�.� �..,�-- MI1�1 -c� <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION#.;. <br /> DESC. <br /> OWNER � ADDRESS CI1Y21P PHONE ' . � <br /> I '� ��.�1 I��� I �'1���' �� �, I� ��11� 1 �>� � �—j �I �� <<�� I �.( 1 � - .�� i,�� , , <br /> - _ ; � �_> <br /> TENANT NAME CONTACY FOR PERMIT PHONE <br /> � L � � - -j�, l�? Z` �`-1 � <br /> � � � �� ��L Y )�� � E-�AIL <br /> CONT C�T�R AO RESS I IZIP P ONE <br /> �'C � t-�;�r����ti� \ �l �ii� � ���( �jL� Li`Lili,�.1C, � � ; � � � � ��� �� ���-� <br /> CONTR.LICENSE# , -i�1� . � C ���- �� ) � � ���LJ (- <br /> ��-t�. l V(.1[ � '(t� ��'L �b'1,,� �N <br /> USE Ok BUILDIN HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � u� <br /> {� .-���i ���� ��.t � ���vi� �Eleclric _Gas_Other (o � � <br /> WORK DESCRIPTION <br /> � <br /> , � , <br /> �� �iC��'�l � ib� � � � ��, (. �, �, 1 , <br /> �,.t.a��� 1 r � C- <br /> PLUMEiING MECHANIC/1L <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathtub = Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower W ater heater <br /> _ Kitchen sink 8 disposai Gas(ireplace <br /> Dishwasher Gasrange <br /> _ Clolhes washer Clothes dryer \'\ <br /> = Waler heater Range hood \\ \\ <br /> Sink(service/bar/mop/etc.) Exhaust(an <br /> Backflow preventer Heat pump <br /> Urical Unit heater <br /> _ Drinking Fountain Boiler ' <br /> Floor drain Refrigeration \ � <br /> _ Grease Irap Woodslove � ,; (1 l <br /> _ Roofdrains _ Olher ; ��!�;���- <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> I hereby ceritify lhat I have read and e�x2mined this application and know the same to be true and correcL All provisions of laws and <br /> ordinaces governinc� this rype of wqrk will be complied\vith whelher specified herein or noL The granling of a permit does not presume <br /> to give authority to violate or canccN the provision oi an�y other slate or local law regulating construc6on or the performance of <br /> conslruclion.ThaC(aii�authorized by ihe awner of this pmpaAy to perform Ih work(or which applicalion is made and I comply wilh the <br /> Slale Contraclors Law 827 RCW and 296�.'2D@ WAC. �� <br /> i <br /> —`, � —�. I � �� ;�v �.1 � � �; i� <br /> Signature of OwnedCOrlractodAUthonzed Agent Cat i <br /> / ` � <br /> �� <br />