Laserfiche WebLink
P�RMIT APPLICATI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APpLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBi & CREDR CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />21(0 oc.YMp�G ��v <br />LEGAL� LOT NO. BLOCK <br />7'ENANTNAME <br />PARCEL TAX I.D. � <br />TRACT <br />CONTACTFOR <br />PERMIT A <br />JCG4 ! � <br />PHONE <br />_�-I e av s-r�t 2.T I <br />CONTRACTOR ToM q�{ a� �n/I� �DRE3S CITY2IP PHONE <br />P�O �'�oX- 3� � 5rA!-FU izST L,t�/j , 813 o(.T^e <br />CONTR. LICENSE N T O M H(..{ <br />.�M2 t3i,?G 3 �s-os <br />USE OF BUILDING <br />WORK DESCRIPTION <br />N0. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />,� Lavatory (wash basin) <br />Shawer <br />Kitchen sink & disposal <br />_� Dishwasher <br />Clothes washer <br />Laundry tray <br />� Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />� Grease trap <br />Roof drains <br />�,I Other FLeo� S(�t//C <br />HEATSOURCE <br />Eiectric Gas Other <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heet pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslave <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 7105 <br />I hereby ceritify thal I have read and examined this applicatlon and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a pertnit daes not presume <br />to give aulhority to violate or cancel the provision of any other stale or iocai law regulating constructlon or the performance of <br />construction. That I am authorized by the owner of this property to perfortn the work for which application is made and I camply with the <br />Slate Cor�¢actors Law 18.27 RCW and 296.200 WAC. , <br />� <br />