Laserfiche WebLink
P'ERMiT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 42&257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADORESS �' �7,/ �r PARCEL TAl(I.D.N PEg�M <br /> /eo� Gc�� l'1c,7/�l� /tl �<v Oo L�YOC� ///�'�/ J77 <br /> LEGAL LOTNO. BLOCK TRACT �� <br /> DFSC <br /> OWNER /�ADDRESS CRY21P PHONE , /p z <br /> �✓on�- (.C7a�fb�'I -1/rc%r✓i� /u�� Cyv�/�r� - /oo/ %�/ �c�6���o/f� �fjP�%. �'�a�i <br /> TENANi NAME CONTACT FOR PERMIT PHO�— <br /> �V l�" � I_ C.����� G' '> ��i4 <br /> C (I-�ll- I�/� ��_IVJ�.i !�/ ,� Ti �� CJ <br /> CONTRACTOR � �/ AODRESS � �i� �CITY P PHONE <br /> ��ir�5„�ti���rr,� [�;�� � ��;5;�_; y << ��,�� — <br /> ,t�« ��_.�y L, �"lX•„� y� s"-5'-��'� <br /> CONTR.LICENSE R i �, � I <br /> �c�AS�����������r ���3Y <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I �Electnc _Gas_Other (��-t� �b <br /> WORK DESCRIPTION <br /> �\�\���'Y.,�.Q L;(.� ( --�-.�.CG•��f �L �.�[J�-G_-i \l�'-(J�F-�l�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXNRE OR ITEM NO. TYPE OF FIXTURF OR ITEM <br /> Toilel AIC-a�r handlirg units <br /> BaViWb Faced air systems <br /> Lava�ory(wash basin) Gas p�ping <br /> Shower Water heater <br /> Kltchen sink 8 dlsposal Gas Irteplace <br /> � �ishwasher Gasrange <br /> Clothes washer Cluthes dryer <br /> _, I aundry Ir�y _ Ran9e hoad <br /> Sink(servicelbarhnop/elc) [xhoust lan <br /> , Backllow preveNer _ Heat pump <br /> Unnal _ Unit heater <br /> Drinking Fountain Boder <br /> Floor dram _ Rehigeration <br /> Grease trap _ Woodstove <br /> Rool drain� O�her ___ <br /> S Olher _ <br /> CITY O�tMERETi LOCAL SALES TAX CODE IS]10S <br /> I hereby cenhfy Ihat 1 have read and examine d Uns apphcahon and know the same to be Irue and wnect. All pmvisions of laws and <br /> ordin2ces goveming this lype o1 work v.all be inmphed with whether specihed herein a not The granting ol a permit dces not presume <br /> tu give�ulhonry m wolate or cancel lhe provision ol any other state or local law regulating construdion a Ihe performance ol <br /> ��nnstmr:tion That I am authonzeJ by�he owner ol lhis property to perfam ttie work for which applicatlon is made and I comply with lhe <br /> Slate Contrartors 1 aw 1A 27 RCW and 296 200 WAC <br /> C" Ql LUr.�-�,Q�— � — \3 ' OZ/ <br /> Signature o ned ontractad ut onze geT-�� at-T7 e' <br /> I �. <br />